Background: The emergence of the COVID-19 epidemic threw the world into turmoil. The medical community bore the brunt of the pandemic's toll. It became clear that there was a shortage of medical personnel and resources. Long work hours, and a lack of personal protective equipment (PPE) and social support all had an influence on mental health.

Methods: This cross-sectional study was conducted among Lumbini Medical College Teaching Hospital students and employees in Palpa, Nepal. Data entailing their demographic details, pre-existing comorbidities, or death in the family due to COVID-19 was collected using a self-administered survey. In addition, the level of fear, anxiety, obsession, and functional impairment due to COVID-19 was recorded using previously validated respective scales.

Results: In total, 403 health care workers and trainees participated in our study. The average age of the study participants was 23±4 years, and more than half of them (n=262, 65%) were females. A significant association was found between fear score with age (p=0.04), gender (p-value <0.01) and occupation (p-value<0.001). Participants suffering from chronic diseases (p-value=0.36), and those who had experienced a COVID-19 death in the family (p-value=0.18), were not found to be significantly obsessed with COVID-19. However, for those who had experienced a COVID-19 death in the family (p-value=0.51) and age (p-value=0.34), these factors were not found to be significantly associated with higher anxiety levels. Nursing students suffered from a significantly greater functional impairment than people of other medical professionals (mean score=269.15, p-value < 0.001). A moderately positive correlation was observed between fear, anxiety, obsession, and functional impairment scales.

Conclusion: Unpredictability and uncertainty are considerable in the aftermath of the pandemic. People's psychological well-being deteriorates due to the repercussions of developing a severe sickness, being isolated, and confronting the stigma of being infected. With the health care personnel at the front lines, the stakes are considerably higher for them. This study revealed various socio-demographic characteristics as risk factors for psychological stress in the healthcare personnel of Nepal during the COVID-19 pandemic. A viable answer to this quandary might be adequate psychosocial intervention by health care authorities, increased social support, and the introduction of better mental health management measures for healthcare personnel.

This cross-sectional study was carried out among the staff and students of Lumbini Medical College Teaching Hospital, Palpa, Nepal. The sample size computed using OpenEpi was 384, after taking a confidence level of 95% and a frequency outcome factor of 50%. For more robust results, we included 406 participants in the survey, of which 3 participants who did not consent to participate were excluded from the study. The cohort of healthcare workers and trainees in the present study included doctors, nurses, other health personnel, medical students, and nursing students. The present study was approved by the Institutional Review Committee of LMCTH vide letter IRC-LMC 06-G/020.

The questionnaire was in English and disseminated among the medical and nursing students, doctors, nurses, and other health care staff working at Lumbini Medical College Teaching Hospital (LMCTH) through social media. Complete confidentiality of the participants was maintained by not asking them for any such information.

The questionnaire consisted of five parts. The first part of the questionnaire consisted of demographic information such as gender, age, current occupation, monthly family income. Information regarding respondent's comorbidity, previous contact with any COVID-19 positive case, and if there was a COVID-19 death in their family was also recorded.

The second part of the questionnaire consisted of the fear of the Covid-19 scale adopted from Ahorsu et al.¹ Fear of the COVID-19 scale is a unidimensional scale with robust psychometric properties and consists of seven items and assessed via five-point Likert scale method (strongly disagree = 1; strongly agree = 5).

The third part of the questionnaire was used to see the obsession of Covid-19 in the participants. The scale was adapted from Lee.² There were four items to perceive too much coronavirus thought among the participants over the last two weeks. The participants would rate the items using a five-point time anchored scale (0 = not at all; 4 = nearly every day over the last two weeks). A score of seven or more signified that the person was overthinking of coronavirus.

The fourth part was the coronavirus anxiety scale. It consisted of five items developed by Lee.³ The participants would rate the items using a five-point time anchored scale (0 = not at all; 4 =nearly every day over the last two weeks). The participant scoring of nine or more in the questions was considered anxious about the coronavirus. The fifth part was the work and social adjustment scale (WSAS), a measure of functional impairment adapted from, where the participant could score on a scale of 0-8 where 0 meant not at all impaired, and eight means very severely impaired.⁴ A respondent with a total WSAS score above 20 was considered to have moderately severe or severe psychopathology, scores between 10 and 20 were considered to have a significant functional impairment, but less severe clinical symptomatology and those who scored less than ten were considered to be considered to have subclinical impairments.

Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, New York). The Shapiro-Wilk test assessed normality. Descriptive statistics were used to report frequencies and proportions for the categorical responses. The disparity between categorical variables was checked using the Chi-square test. The association between age and vaccine acceptance was assessed through binary logistic regression. In the case of continuous data, Mann-Whitney U and Kruskal-Wallis tests were used. Spearman's rho was used to assess the correlation between the scales, and P-value <0.05 was considered significant in all cases.

References:

1. Ahorsu DK, Lin C-Y, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. Published online March 27, 2020:1-9. doi:10.1007/s11469-020-00270-8

2. Lee SA. How much “Thinking” about COVID-19 is clinically dysfunctional? Brain Behav Immun. 2020;87:97-98. doi:10.1016/j.bbi.2020.04.067

3. Lee SA. Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Stud. 2020;44(7):393-401. doi:10.1080/07481187.2020.1748481

4. Mundt JC, Marks IM, Shear MK, Greist JH. The Work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180(12):461-464. doi:10.1192/bjp.180.5.461