J Korean Med Sci.  2021 Dec;36(47):e324. 10.3346/jkms.2021.36.e324.

Emotional Distress of the COVID-19 Cluster Infection on Health Care Workers Working at a National Hospital in Korea

Affiliations
  • 1Department of Psychiatry, Bugok National Hospital, Changnyeong, Korea
  • 2Department of Psychiatry, Kosin University Gospel Hospital, Busan, Korea
  • 3Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea

Abstract

Background
Frontline healthcare workers responding to coronavirus disease 2019 (COVID-19) inevitably face tremendous psychological burden. Thus, the present study aimed to identify the psychological impact and the factors contributing to the likely increase in emotional distress of healthcare workers.
Methods
The participants include a total of 99 healthcare workers at Bugok National Hospital. Psychometric scales were used to assess emotional distress (12-item General Health Questionnaire; GHQ-12), depression symptoms (Patient Health Questionnaire-9; PHQ-9), and post-traumatic stress disorder-related symptoms (Impact of Events Scale-Revised; IES-R). A supplementary questionnaire was administered to investigate the experience of healthcare workers exposed to COVID-19-infected patients. Based on the results of GHQ-12 survey, participants were categorized into two groups: distress and non-distress. All the assessed scores were compared between the two groups. A logistic regression model was constructed to identify factors associated with emotional distress.
Results
Emotional distress was reported by 45.3% (n = 45) of all participants. The emotionally distressed group was more likely to be female, manage close contacts, have higher scores on PHQ-9 and IES-R, feel increased professional risk, and report that proper infection control training was not provided. Female gender, managing close contacts, higher scores on PHQ-9, and a feeling that proper infection control training was not provided were associated with emotional distress in logistic regression.
Conclusion
Frontline healthcare workers face tremendous psychological burden during the COVID-19 pandemic. Therefore, appropriate psychological interventions should be provided to the HCWs engaged in the management of COVID-19-infected patients.

Keyword

COVID-19; Healthcare Worker; Psychological Impact; Distress; Depression; PTSD

Reference

1. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020; 55(3):105924. PMID: 32081636.
Article
2. World Health Organization (WHO). Director-General's opening remarks at the media briefing on COVID-19-11 March 2020. Accessed July 21, 2021. https://www.who.int/director-general/speeches/detail/who-director-generals-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 .
3. World Health Organization (WHO). Coronavirus disease (COVID-19) pandemic. Accessed July 21, 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019 .
4. Korean Society of Infectious Diseases and Korea Centers for Disease Control and Prevention. Analysis on 54 mortality cases of coronavirus disease 2019 in the Republic of Korea from January 19 to March 10, 2020. J Korean Med Sci. 2020; 35(12):e132. PMID: 32233161.
5. Central Disaster Management Headquarters. Cases in Korea. Accessed July 21, 2021. http://ncov.mohw.go.kr/en/ .
6. Korea Centers for Disease Control and Prevention. Guideline for management of COVID-19. Accessed July 21, 2021. http://kdca.go.kr/board/board.es?mid=a20507020000&bid=0019&act=view&list_no=712602 .
7. Yoon YK, Lee J, Kim SI, Peck KR. A Systematic narrative review of comprehensive preparedness strategies of healthcare resources for a large resurgence of COVID-19 nationally, with local or regional epidemics: present era and beyond. J Korean Med Sci. 2020; 35(44):e387. PMID: 33200593.
Article
8. Korean Society of Infectious Diseases. Korean Society of Pediatric Infectious Diseases. Korean Society of Epidemiology. Korean Society for Antimicrobial Therapy. Korean Society for Healthcare-associated Infection Control and Prevention. Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2. J Korean Med Sci. 2020; 35(10):e112. PMID: 32174069.
9. Yoo JH. The fight against the 2019-nCoV outbreak: an arduous march has begun. J Korean Med Sci. 2020; 35(4):e56. PMID: 31997618.
Article
10. Lee JY, Lee JY, Lee SH, Kim J, Park HY, Kim Y, et al. The experiences of health care workers during the COVID-19 pandemic in Korea: a qualitative study. J Korean Med Sci. 2021; 36(23):e170. PMID: 34128598.
Article
11. Styra R, Hawryluck L, Robinson S, Kasapinovic S, Fones C, Gold WL. Impact on health care workers employed in high-risk areas during the Toronto SARS outbreak. J Psychosom Res. 2008; 64(2):177–183. PMID: 18222131.
Article
12. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009; 54(5):302–311. PMID: 19497162.
Article
13. Hong X, Currier GW, Zhao X, Jiang Y, Zhou W, Wei J. Posttraumatic stress disorder in convalescent severe acute respiratory syndrome patients: a 4-year follow-up study. Gen Hosp Psychiatry. 2009; 31(6):546–554. PMID: 19892213.
Article
14. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020; 88:901–907. PMID: 32437915.
Article
15. Oladunjoye A, Oladunjoye O. An evolving problem-mental health symptoms among health care workers during COVID-19 pandemic. Asian J Psychiatr. 2020; 54:102257. PMID: 32634711.
Article
16. Kontoangelos K, Economou M, Papageorgiou C. Mental health effects of COVID-19 pandemia: a review of clinical and psychological traits. Psychiatry Investig. 2020; 17(6):491–505.
Article
17. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020; 7(3):e14. PMID: 32035030.
Article
18. Mak IW, Chu CM, Pan PC, Yiu MG, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009; 31(4):318–326. PMID: 19555791.
Article
19. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979; 9(1):139–145. PMID: 424481.
Article
20. Goldberg D, Williams P. A User's Guide to the General Health Questionnaire. Windsor, UK: NFER-Nelson;1988.
21. Kim YJ, Cho MJ, Park S, Hong JP, Sohn JH, Bae JN, et al. The 12-item general health questionnaire as an effective mental health screening tool for general Korean adult population. Psychiatry Investig. 2013; 10(4):352–358.
Article
22. Park JI, Kim YJ, Cho MJ. Factor structure of the 12-item General Health Questionnaire in the Korean general adult population. J Korean Neuropsychiatr Assoc. 2012; 51(4):178–184.
Article
23. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999; 282(18):1737–1744. PMID: 10568646.
24. Choi JH, Choi HS, Ko HJ, Park KH, Joo KJ, Ga H, et al. Standardization of the Korean version of Patient Health Questionnaire-9 as a screening instrument for major depressive disorder. Korean J Fam Med. 2007; 28(2):114–119.
25. Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979; 41(3):209–218. PMID: 472086.
Article
26. Eun HJ, Kwon TW, Lee SM, Kim TH, Choi MR, Cho SJ. A study on reliability and validity of the Korean version of impact of event scale-revised. J Korean Neuropsychiatr Assoc. 2005; 44:303–310.
27. Lee SH, Juang YY, Su YJ, Lee HL, Lin YH, Chao CC. Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry. 2005; 27(5):352–358. PMID: 16168796.
Article
28. Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004; 185(2):127–133. PMID: 15286063.
Article
29. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3(3):e203976. PMID: 32202646.
Article
30. Park C, Hwang JM, Jo S, Bae SJ, Sakong J. COVID-19 outbreak and its association with HCWs' emotional stress: a cross sectional study. J Korean Med Sci. 2020; 35(41):e372. PMID: 33107230.
Article
31. Cabarkapa S, Nadjidai SE, Murgier J, Ng CH. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: a rapid systematic review. Brain Behav Immun Health. 2020; 8:100144. PMID: 32959031.
Article
32. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123–127. PMID: 30343247.
Article
33. Pouralizadeh M, Bostani Z, Maroufizadeh S, Ghanbari A, Khoshbakht M, Alavi SA, et al. Anxiety and depression and the related factors in nurses of Guilan University of Medical Sciences hospitals during COVID-19: a web-based cross-sectional study. Int J Afr Nurs Sci. 2020; 13:100233. PMID: 32837911.
Article
34. Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res. 2020; 290:113130. PMID: 32497969.
Article
35. Wang LQ, Zhang M, Liu GM, Nan SY, Li T, Xu L, et al. Psychological impact of coronavirus disease (2019) (COVID-19) epidemic on medical staff in different posts in China: a multicenter study. J Psychiatr Res. 2020; 129:198–205. PMID: 32763586.
Article
36. Liu Y, Wang L, Chen L, Zhang X, Bao L, Shi Y. Mental health status of pediatric medical workers in China during the COVID-19 outbreak. Front Psychiatry. 2020; 11:702. PMID: 32792998.
Article
37. Chung H, Kim EO, Kim SH, Jung J. Risk of COVID-19 transmission from infected outpatients to healthcare workers in an outpatient clinic. J Korean Med Sci. 2020; 35(50):e431. PMID: 33372425.
Article
38. Nayak BS, Sahu PK, Ramsaroop K, Maharaj S, Mootoo W, Khan S, et al. Prevalence and factors associated with depression, anxiety and stress among healthcare workers of Trinidad and Tobago during COVID-19 pandemic: a cross-sectional study. BMJ Open. 2021; 11(4):e044397.
Article
39. Afifi WA, Felix ED, Afifi TD. The impact of uncertainty and communal coping on mental health following natural disasters. Anxiety Stress Coping. 2012; 25(3):329–347. PMID: 21801075.
Article
40. Gavin B, Hayden J, Adamis D, McNicholas F. Caring for the psychological well- being of healthcare professionals in the Covid-19 pandemic crisis. Ir Med J. 2020; 113(4):51. PMID: 32268045.
41. Person B, Sy F, Holton K, Govert B, Liang A. National Center for Inectious Diseases/SARS Community Outreach Team. Fear and stigma: the epidemic within the SARS outbreak. Emerg Infect Dis. 2004; 10(2):358–363. PMID: 15030713.
Article
42. Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci. 2020; 16(10):1745–1752. PMID: 32226294.
Article
43. Lee YR, Lee JY, Park IH, Kim M, Jhon M, Kim JW, et al. The relationships among media usage regarding COVID-19, knowledge about infection, and anxiety: structural model analysis. J Korean Med Sci. 2020; 35(48):e426. PMID: 33316862.
Article
44. Shih FJ, Gau ML, Kao CC, Yang CY, Lin YS, Liao YC, et al. Dying and caring on the edge: Taiwan's surviving nurses' reflections on taking care of patients with severe acute respiratory syndrome. Appl Nurs Res. 2007; 20(4):171–180. PMID: 17996803.
Article
45. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020; 26:e923549. PMID: 32132521.
Article
46. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020; 7(3):228–229. PMID: 32032543.
Article
47. Hu N, Mao H. Emergency management of mental hospitals during the outbreak of COVID-19. Psychiatry Investig. 2020; 17(5):489–490.
Article
48. Tian Y, Nian B, Ma Y, Guo X, Wang F, Rong L. The status of occupational protection during COVID-19 pandemic: knowledge, attitudes, and practice of healthcare workers in endoscopy units, China. Front Public Health. 2021; 9:632608. PMID: 33829007.
Article
49. Veenema TG, Walden B, Feinstein N, Williams JP. Factors affecting hospital-based nurses' willingness to respond to a radiation emergency. Disaster Med Public Health Prep. 2008; 2(4):224–229. PMID: 19050428.
Article
50. Ogedegbe C, Nyirenda T, Delmoro G, Yamin E, Feldman J. Health care workers and disaster preparedness: barriers to and facilitators of willingness to respond. Int J Emerg Med. 2012; 5(1):29. PMID: 22716272.
Article
51. Agaibi CE, Wilson JP. Trauma, PTSD, and resilience: a review of the literature. Trauma Violence Abuse. 2005; 6(3):195–216. PMID: 16237155.
52. Murray EJ, Mason M, Sparke V, Zimmerman PP. Factors influencing health care workers' willingness to respond to duty during infectious disease outbreaks and bioterrorist events: an integrative review. Prehosp Disaster Med. 2021; 36(3):321–337. PMID: 33618789.
Article
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