Q & A - Pratik Khanal

In Nepal, why has it been important to study the mental health impacts of Covid-19 on healthcare workers?

Health workers are working at a greater risk of contracting Covid-19 due to the nature of their work. The fear of being infected due to increased exposure, and the fear of spreading the virus to others make them prone to suffering from mental health symptoms.

The health system in Nepal suffers from a chronic shortage of human resources, inadequate medical supplies as well as under-investment in health infrastructure and capacity enhancement.

The feeling of being inadequately supported by the health facility management and the government; such as in the supply of personal protective equipment, training for infection prevention and other incentives also puts health workers into despair.

In this context, the study to explore the mental health impacts of COVID-19 on health workers of Nepal was necessary to not only unveil the burden of mental health problems, but also to suggest the government and concerned authorities act on reducing the consequences of mental health problems.

Please tell us briefly about your survey and results. How did your study methods change due to restrictions imposed by the pandemic?

Among 475 study participants, 41.9% of health workers had symptoms of anxiety; 37.5% had some form of depression and 33.9% had symptoms of insomnia. We used the Hospital Anxiety Depression Scale (HADS) to measure the anxiety and depression, and Insomnia Severity Index to measure the insomnia among health workers. In this study, 21.1% of health workers reported adequacy of precautionary measures in their workplace and 53.7% of health workers mentioned that they faced stigma due to Covid-19.

Health workers facing stigma and those with a history of medication for mental health problems had higher odds of developing symptoms of all mental health outcomes, while those reporting inadequate precautionary measures in their workplace were more at risk of developing symptoms of anxiety and depression. Similarly, nurses were more likely than other health workers to develop symptoms of anxiety.

Due to a nationwide lockdown, we could not conduct face to face interviews and observe the service sites. Instead, we developed an online questionnaire, interacted with health workers by telephone or email, and sent them a questionnaire to fill in.

For what reasons are healthcare workers stigmatized by communities during Covid-19?

While our research did not investigate the reasons behind stigmatizing health workers by communities during Covid-19, based on our opinion and context, it is basically the fear of getting infected from health workers that has propelled communities to be scared of, and stigmatize health workers.

On one hand, proper risk communication has not been done involving communities, while on the other hand, the civil societies including media have also not been strongly involved and mobilized to inform the communities about infection transmission and respecting the dignity of health workers.

Our study has revealed that health workers faced stigma due to their profession; accused of being a carrier, threatened or asked to leave a rented place. As health workers are already vulnerable due to the nature of their work, health professionals should not battle the community stigma alone.

This will require community engagement strategies along with proper risk communication and also, enforcing law and order.

“It is basically the fear of getting infected from health workers that has propelled communities to stigmatize and be scared of health workers.”

Why were nurses more at risk of anxiety and depression than other healthcare staff?

As nurses work closely with patients and spend more time in taking care of patients at wards as well as intensive care units, they are more likely to experience symptoms of mental health problems.

The work stress, social isolation, and Covid-19 induced fear might also fuel the developing mental health problems. Similarly, in Nepal, as nurses are mostly females, and because of their role to provide care to their children, this may also have played a role in increasing vulnerability to mental health problems compared to other health workers.

How could healthcare workers at risk be better supported to reduce negative mental health impacts?

The psychological impacts of a disease outbreak are usually neglected during pandemics despite the high burden caused. The foremost priority for reducing negative mental health impacts among health workers should be in creating an enabling work environment with a good support system.

This might include adequate availability of personal protective equipment, proper training on infection prevention, work rotation, while providing incentives and support in case of being infected.

It is also necessary to provide educational interventions such as learning from peers and coping with work stress.

Similarly, interventions such as the mobilization of trained counselors for the psychological support of health workers should also be a part of health sector response. The reduction of stigma among health workers working in the Covid-19 response should be prioritized through the mobilization of mass media and community engagement strategies.

Strict measures against stigmatization and activities, such as forcing health workers to leave their rented home, should be taken to support health workers to promote their dignity in the community where they work.

“Psychological impacts of a disease outbreak are usually neglected during pandemics..”