A study on Mental Health assessment among the Resident Doctors, House Surgeons, during the Corona virus Disease-2019 pandemic

INTRODUCTION: Mental health issues among medical students are well recognized worldwide, with medical education accounting for one the most stressful of learning environments. Medical students are more anxious and depressed than their peers, and the prevalence of various mental health problems is on the rise.[(1,2)]With an ever increasingly competitive climate, mental morbidity and stress are seen to increase along with the years of training.[(3)] While the factors such as heavy workload and concerns about the examinations may even be essential for all-round development, they result in burnout, lack of sleep, and have an adverse effect on academic performance.[(4,5)] Physician and medical student suicides have become alarmingly common in the present day. Much priority is not afforded to the mental health of health-care personnel, despite growing evidence of untreated mental disorders in this group.[(4)] Mental health issues among medical students are also often unreported owing to stigma due to several factors, such as, fear of being evaluated poorly by faculty members, diminished respect from peers, or being perceived as unable to handle responsibilities.[(6)] A higher incidence of substance abuse is also noted in medical students, and these habits are usually new and persist throughout adulthood.[(7)] As future health-care providers, medical students require early attention and support systems for their well-being during medical school. The severe acute respiratory syndrome coronavirus-2 pandemic has had far reaching psychosocial effects globally.[(8,9)] In March 2020, the government of India announced a nationwide lockdown, as an essential and effective measure for breaking the coronavirus disease 2019 (COVID-19) transmission cycle. The psychosocial effects of the pandemic as well as the lockdown, such as depression, anxiety, and panic have taken a toll on the entire population and medical professionals, resident doctors and House surgeon have been no exception. The pandemic marked an end to normal day-to-day life. Uncertainty and uneasiness have pervaded in the medical student community, who have now not been exposed to classroom or clinical experience for almost 3 months due to the lockdown restrictions. Ambiguity about the future, especially in relation to examinations, curriculum, promotion to the next semester, commencement of internship, competitive examinations, and finding employment, is likely to aggravate any preexisting mental health problems in the medical student, adding to the feelings of anxiety, and self-doubt. This study assesses the mental health of medical health professionals, residents and house surgeons during the COVID-19 pandemic by employing a general health questionnaire (GHQ). The prevalence of mental health issues is estimated, and associations between mental health status and other demographic variables are also studied. METHODOLOGY: This was a cross-sectional study conceptualized and designed at a tertiary-care teaching hospital in Khammam,Telangana. Sample size was calculated taking prevalence value = 50%, precision = 4%, α = 0.05, and 95% confidence interval, and the minimum required sample size was 60. This study included a sample of 105 medical resident doctors and house surgeons at Mamata Medical college, Khammam, Telangana. The GHQ-28 was adapted to GoogleForms® and administered to the medical professionals at Mamata medical college. The survey was circulated extensively across Mamata medical college, and the responses were collected for a period of 1 month from april 30, 2021 to july 5, 2021. Informed consent was obtained along with the survey responses, and confidentiality issues were explained to all the respondents of the survey. Surveys with incomplete responses were excluded. The questionnaire is divided into four parts by the factor analysis. Questions (Q) 1 to Q7 are for somatic symptoms, Q8 to Q14 are for anxiety/insomnia, Q15 to Q21 are for social dysfunction, and Q22 to Q28 are for depression. Hence, a somatic symptoms score, anxiety/insomnia score, social dysfunction score, depression score, and total GHQ score are calculated. Each of the four subscores and the total score were treated as continuous measures and analyzed for association with other variables. A Likert scale ranging from 0 to 3, signifying “not at all,” “no more than usual,” “rather more than usual,” and “much more than usual” was employed for the GHQ-28. The total score hence ranged from 0 to 84. The GHQ-28 has been translated and validated in over 38 different languages since its introduction, and this study utilized the English version. We used a cutoff score of >23 to define an abnormal GHQ score. The Cronbach’s alpha of reliability for the GHQ-28 has been reported to vary from 0.78 to 0.95.[(10,11)] STATISTICAL ANALYSIS: Sciences, Version 20 (IBM Corp., SPSS statistics for windows, Armonk, NY, USA)[(12)] for Windows (version 21) and Microsoft Excel 2010. Categorical variables were analyzed with the Chisquare test. Statistical significance levels for all analyses were set at the P = 0.05. RESULTS: This study included 105 medical professionals including House surgeons and Resident doctors practicing in different clinical departments, working at Mamata Medical college, khammam,Telangana. Mean age for the study sample is 25.28years, there were 43 male and 62 female at total of 105 medical professionals out of which 17 were male House surgeons and 35 female house surgeons, 26 were male residents and 27 female residents. In this study 70 participants have scored >23 GHQ score. Females were shown to have higher GHQ score >23 than the male participants. A correlation coefficient was computed to assess the relationship between GHQ 28 score with the male and female residents and house surgeon. But statistically insignificant p value was emerged that is 0.57, as the p value is taken as <0.05, Chi square statistics with Yates correction is 0.0138, p value is 0.71 which is not significant at p<0.05. The questionnaire is divided into four parts by the factor analysis. Questions (Q) 1 to Q7 are for somatic symptoms, Q8 to Q14 are for anxiety/insomnia, Q15 to Q21 are for social dysfunction, and Q22 to Q28 are for depression. These individual scores were compared among the male and female participants out of whom p value was not significant for Somatic, Social dysfunction and Depression. But p value was significant for Anxiety when compared among the male and female participants which signifies that females were more prone to anxiety than male participants, as the female participants scored GHQ score of >23 more than male participants. The two-tailed P value equals 0.0122 By conventional criteria, this difference is considered to be statistically significant for Anxiety among the male and female participants. DISCUSSION: This study assessed psychological morbidity among Medical health professionals during the COVID-19 pandemic, and several findings have emerged. A staggering 60 % of participants had an abnormal GHQ score, which was higher than the prevalence rates reported by other authors in similar studies in India and worldwide.[(13,-15)] Medical training-related distress is a well-known phenomenon and goes hand in hand with the difficulty and the challenges of the profession. In them present day, competition in the field of medicine is at an all-time high, and failure to contend against over 100,000s of others carries a steep cost. The realization that the pandemic is here to stay has set in, with most of the participants believing that the pandemic will continue to affect them for 6 months or more. This study found that almost one-thirds of participants felt, particularly uneasy and uncertain about their careers and future on account of this pandemic, and these participants were twice as likely to score higher on the GHQ questionnaire. This study also saw females being two times as likely to have mental health issues. Females may tend to show the higher levels of psychological distress due to a decreased sense of coherence and less social support, as hypothesized and described in other studies.[(13,16)] This study has revealed that An emphasis on early intervention and an open culture that permits the expression of personal grievances and struggles is of paramount importance. A learning environment that punishes a student for underperformance is counterproductive and not conducive to personal improvement. On the other hand, the medical profession is one that demands intense resilience and patience, and it is through friendly guidance from faculty that this goal becomes achievable for a medical student. The inclusion of mentorship programs between faculty and students and mandatory appointment of trained counsellors in medical schools is a step in the right direction. The role of yoga, meditation, and mindfulness has also been studied extensively as a means to reduce the stress and anxiety.[(17,18)] Widespread application of these modalities for the psychological well-being of medical students could prove promising and are the need of the hour if we want the health of our future generations in capable hands. CONCLUSION: Mental health issues are very common among medical professionals, which may be aggravated now during the COVID-19 pandemic. The factors such as uncertainty caused by pandemic, female sex were associated with greater mental health issues. Even disregarding the pandemic as a stressor, guidance and counselling, and intervention at the individual, group and community levels are still essential for the all-round development of medical professionals. Further studies utilizing various tools to assess mental health may be warranted. LIMITATIONS: This study was an open survey of medical professionals at Mamata Medical College, Khammam, and thus a systematic approach to sampling was followed. The GHQ-28 was merely a single tool used in this study to assess mental health and may not accurately depict the complete picture. While uncertainty due to the COVID-19 pandemic was strongly associated with mental health problems in this study, it cannot be determined what proportion of these problems was pre-existing, to arrive at a causeeffect relationship between the pandemic and mental health problems. REFERENCES: 1. Hope V, Henderson M. Medical student depression, anxiety and distress outside North America: A systematic review. Med Educ 2014;48:963-79. 2. Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med 2011;86:116-21. 3. Dyrbye LN, Thomas MR, Shanafelt TD. 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