The Psychological Impact Of Covid 19 Pandemic: A Study With Reference To Women
Doctors In Tirunelveli District
Mrs. A. Rajeswaria, Dr. K. S.Arcokiasamyb, Dr. J. Dasnavis Jeyanthic
aPh.d Scholar, Reg no: 19121281012024, Research Centre : St.Xaviers College (Autonomous) & Assistant Professor,
Department of Commerce, A.P.C. Mahalaxmi College for Women, Thoothukudi, Affiliated to M S University,Tirunelveli, Tamilnadu.
b Assistant Professor, Department of Commerce, St.Xaviers College (Autonomus), Palyamkotai, Tirunelveli, Tamilnadu
c Assistant Professor, Department of Economics, A.P.C. Mahalaxmi College for Women, Thoothukudi, Tamilnadu
Article History: Received: 11 January 2021; Revised: 12 February 2021; Accepted: 27 March 2021; Published online: 28 April 2021
Abstract: Corona virus disease (COVID-19) is an infectious disease caused by a newly discovered corona virus. Most people
who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment. The virus that causes COVID-19 is mainly transmitted through droplets generated when an infected person coughs, sneezes, or exhales. These droplets are too heavy to hang in the air, and quickly fall on floors or surfaces. You can be infected by breathing in the virus if you are within close proximity of someone who has COVID-19, or by touching a contaminated surface and then your eyes, nose or mouth. The World Health Organization (WHO) in January 2020 declared outbreak of novel corona virus disease, COVID-19, an international public health emergency. It was stated that there was high COVID-19 spread risk to various other countries across world. According to WHO in March 2020, COVID-19 was characterized as pandemic. However, this sudden crisis is generating great deal of stress, anxiety, and depression throughout the world. Aim: The aim of this study was to assess the psychological impact and various associated factors during the developing COVID-19 situation among both the healthcare and non-healthcare working professionals in India. Materials and Methods: This was an observation-based cross-sectional study conducted during the lockdown period and following the lifting of the lockdown for a total of 3 months duration. A structured questionnaire was send via the (email) electronic mail system to a target population of 350 people. Out of which 300 responded. The questionnaire was comprised of study variables: (a) Gender; (b) age-group range which was categorized into- (i) Between 30 snf 50 years and (ii) More than 50 years; (c) Presence of any comorbid medical condition; psychological symptoms of- (d) insomnia; (e) anxiety; and (f) depression. Statistical analysis was performed using the Chi-square test for determining significance. Results: Mean ± SD values for age were found to be 35.54 ± 6.09; 33.84 ± 7.87; 32.16 ± 5.89 and 55.76 ± 8.98 for physicians, women Doctors, technical staff, and non-healthcare professionals while the percentages of male study participants was found to be 37.2%, 15%, 57%, and 65% and female study participants was 62.8%, 85%, 43%, and 35% for the physicians, nursing staff, technicians, and non-healthcare professionals. Depression, insomnia, and anxiety between healthcare and non-healthcare professional workers, demonstrated significant P values of 0.05, 0.03, and 0.02, respectively. Conclusion: The present study has shown a significant psychological impact arising from this crisis.
Keywords: Anxiety, depression, healthcare, non-healthcare, stress 1. Introduction
Several pandemics of communicable diseases have been experienced by the globe in the past decades such as SARS, H1N1, Ebola, Zika, and MERS. The COVID-19 pandemic in India is part of global pandemic caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which was originated from China. In India the first case of COVID-19 was reported on 30 January 2020 and currently has the leading number of confirmed cases in Asia and has the second-highest number of confirmed cases in the world after the United States, with more than 9 million reported cases of COVID-19 infection and more than 100 thousand deaths. India with over 90,000 cases reported per day during mid-September and the per day cases were slowly come down to below 25,000 during last of December 2020.
The COVID-19 Pandemic in the Indian State, Tamilnadu
In Tamilnadu, the first case of the COVID-19 pandemic was reported on 7th March 2020. In India, Tamilnadu
stands in the 4th highest number in confirmed cases, after Maharashtra, Andhra Pradesh and Karnataka. In
Tamilnadu, the recovery rate is 97.48% and mortality rate is 1.48%. As per the Health Department, 84% of deaths were among those with comorbidities while 88% of the patients are asymptomatic.
The Role of Women Doctors in a Pandemic
The main concern to treatment capability is not the number of beds in hospitals, not even the number of intensive care units with ventilators facilities but really it is the number of suitability of skilled women Doctors available to provide care in those covid-19 patients’ wards.The swiftness of the COVID-19 trapped many off-guard, but luckily, the largest skilled contingent of healthcare workers around the world were uniquely equipped
to deal with the prolonged crisis of a pandemic. While researchers are battling with these deadly viruses in clinics and laboratories, women Doctors are facing this threat by directly interacting with uncountable patients who may be carrying the virus. Women Doctors are perfect for this job patients.
2. Review Of Literature
Originating as a cluster of unexplained cases of pneumonia in Wuhan, China, novel corona virus disease – officially designated as COVID-19 by the World Health Organization – has reached the level of a pandemic, affecting countries all across the world. To date (March 30th, 2020), over 720,000 confirmed cases and 33,000
deaths attributable to this disease have been reported. In the wake of this global health crisis, stringent public health measures have been implemented to curtail the spread of COVID-19 (Adhikari et al., 2020).
The health alert state declared by the WHO due to the COVID-19 pandemic merited this the greatest challenge faced by societies since the Influenza virus. Countries like the United States, France, the United Kingdom, Spain, or Brazil were forced to adopt policies without precedents to prevent the spread of the virus (Thakur and Jain, 2020). These actions were mostly taken only when fear was already evident in society and involved the restrictions of free movement, closure of airports and shops, and the total confinement of the population (Xiao et al., 2020a). Thus, within the space of 1 day, citizens went from experiencing a generalized feeling of uncertainty and lack of information to being notified of their confinement in their homes to avoid infection and the collapse of the health systems. Countries found themselves unable to cope with the increasing number of daily cases and to administer correct treatments due to the lack of technical and human resources (Liu et al., 2020). Fear was evident in society, from fear of contagion, fear of how the virus was transmitted, fear of the future, of losing jobs, to fear for loved one’s health (Shanafelt et al., 2020).
Therefore, citizens are experiencing an extremely stressful and novel living situation, one which is impacting each subject in different ways and undoubtedly leading to psychological consequences in the medium and long term (Holmes et al., 2020). Confinement is an anomalous situation that forces people to modify their normal life habits and daily routine (Girdhar et al., 2020). Suddenly, normal activity comes to a halt; even in cases where it is possible to continue with work, the person modifies their natural way of acting: they no longer wake up every day to the rhythm of the alarm clock, do not get dressed and clean, do not leave the house to go to work, do not take public or private transport to get to their work location, do not interact for at least 8 h a day with their colleagues, and they do not organize the rest of the day to attend to other family and social obligations (Venkatesh and Edirappuli, 2020).
During confinement, the person is forced to suddenly stop their life, and although in the first days a brief relief is felt due to this stop, like that produced during the vacation period, the person quickly begins to present symptoms associated with anxiety produced by social isolation, lack of mental hygiene habits, and repeated exposure to negative news and information. Thus, feelings of sadness, apathy, fear, uncertainty, frustration, lack of impulse control, anxiety, alterations of the circadian cycles, insomnia, hypervigilance, or difficulties in concentrating may appear (Kumar and Nayar, 2020).
In this line, it is important to consider that people with mental pathologies existing before the pandemic should be extremely cautious about the fulfillment of some rules that prevent a worsening of the symptoms associated with their diagnosis (Tsamakis et al., 2020). While for people without previous pathologies, it should be equally important to be aware to apply different prevention actions to maintain a balanced mental health during the complex and unusual situation of social isolation in the pandemic (Ahmed et al., 2020).
Consequently, it would be indispensable for people to create a series of habits that protect their mind from these associated negative factors (Pancani et al., 2020). Amongst these, previous authors highlighted the need to control exposure to the news, and to limit choices to the most reliable sources. People are encouraged to try to normalize the day-to-day by creating healthy routines, maintaining as far as possible those that we had previously internalized, such as exercising at a certain time each day. Daily rituals should be established if possible; when the subject can maintain his/her work activity, it was recommended to maintain a more or less established schedule, trying to separate personal life from work. When a person cannot maintain such activity, a reasonable part of the day should be dedicated to actively seeking employment, then the feeling of having been productive can increase. Personal care rituals should also be practiced as we would do daily (Lippi et al., 2020).
In short, in a state as exceptional as the one society is experiencing now, we must act in the most rational way possible to try to prevent not only the worsening of the pandemic but also the exacerbation of mental disorders.
Vijay Raghavan,Nadia Jabbarkhail and Akbar Ahmady (2020), in their research paper, “Health Worker’s Perception Survey on Covid 19” concluded that based on the study, protective equipment for medical staff and health workers are not sufficient. Some medical staff has less awareness about the precautious steps required to
avoid infection. There existed shortage of testing kits and noticed very few laboratories exist in the country for testing and so, there was delay in getting results.
Pierre A. Geoffroy, Ve´ronique Le Goanvic1, Olivier Sabbagh, Charlotte Richoux, Aviv Weinstein, Geoffrey Dufayet and Michel Lejoyeux (2020), in their research paper “Psychological Support System for Hospital Workers During the Covid-19 Outbreak: Rapid Design and Implementation of the Covid-Psy Hotline”, concluded that their findings highlighted the need for health authorities to be intimated of the psychological impact of a pandemic on the welfare and performance of their employees in order to provide the psychological support and the required help.
Judith E. Arnetz, Courtney M.Goetz, Bengt B. Arnetz and Eamonn Arble (2020), in their article “Women Doctor reports of stressful situation during Covid-19 pandemic: Qualitative analysis of survey responses” concluded that opportunities must be given to the women Doctors to express their stress and the supportive needs and suggestions would be given for adaptation of workplace during this pandemic period in order to find out the possible organisational interventions to maintain women Doctors’ safety, health and wellbeing.
3. Statement Of The Problem
In the beginning of the pandemic, women Doctors and other healthcare workers were the major victims as there wasn’t much awareness available about the novel Corona virus. During these pandemic outbreaks, higher level of psychological stress has been experienced by women Doctors who were in care of infected patients. They faced difficulty in communicating with patients because of the highly protected mask would muffled voices and this lacking in communication resulted in restless mood for patients and that also certainly added to the challenges which women Doctors were facing. In most hospitals, women Doctors work on shifts on seven days of duty, followed by seven days of isolation. With the virus having 1,02,83,742 lives so far, death has become a daily occurrence for the Doctors. By being on the frontline of a virus outburst, women Doctors and other healthcare workers undertake the risk of contracting the disease. When taking care of sick patients, they may also highly vulnerable to the virus even though they followed all safety procedures. While newer medicines and upgraded equipments have reduced the risk to women Doctors in recent time, they should still exercise caution, for the sake of them, their friends and family with whom they have fixed contact. Higher stress levels and longer shifts are expected to occur during a pandemic, which may leads to burnout for many women Doctors. When fighting against disease, managing stress and avoiding burnout must be a top priority. Therefore, women Doctors must take all the necessary precaution to protect themselves both physically and psychologically. And hence, mental health initiatives are vital to support women Doctors during an unprecedented health crisis of a pandemic.
4. Objectives Of The Stud
➢ To Understand the degree of stress of women doctor due to Covid-19
➢ To examine the psychological distress, depression, anxiety, and stress experienced by Women Doctors due to Covid-19
5. Methodology Primary Data:
The present study is an empirical survey and data collected through online questionnaire using Google Forms and distributed it through social media, email, and messages to reach women Doctors. The researcher contacted women Doctors from nearby hospitals who were available and easy to contact. In this study, the researcher used a snowball sampling method, one of the non probability sampling techniques is adopted and 120 women Doctors working in Government Hospitals in Tirunelveli District, Tamil Nadu, constitute the sample for the study. Participants: The study was carried out on 120 Women doctors (Psychiatrists, radiologists, pediatricians, gynecologists and Medicine) who were posted in COVID 19 wards in some or the other shift. The doctors were assigned duties in the two COVID- 19 hospitals of Tirunelveli and Palayamkottai where the study was carried out. The long and tedious working hours in the hospital came with additional responsibility of maintaining and recording the data of COVID patients. After the 15 day long duty in the hospital these doctors were required to stay alone in a separate accommodation where they were quarantined for fourteen days. This long separation from family and friends disturbed their lives leading to immense stress. Their morale went down drastically. The issue of balancing work life was especially challenging for female doctors having young children.
Secondary Data:
6. Area Profile
Tirunelveli District is one of the 38 districts of Tamilnadu State in Southern India. The district was formed by bifurcation of Tirunelveli district on 20th October 1986. Tirunelveli is the capital and the main town of the district,
the district is known for pearl cultivation, with an abundance of pearls being found in the seas offshore. It was formerly ruled by one of the oldest kingdoms in India, the Pandya Dynasty with the port of Korkai through which trade with Rome happened.
Tirunelveli District comprises of 1 Corporation, 2 Municipalities, 12 Panchayat Unions and 19 Town Panchayats. It is comprised of all types of health care services from diagnosis centres to treat the suffering of the patients. The district has 1 medical college hospital, 9 Government hospitals, 52 Primary health centres (Rural) and 82 Primary health centres (Urban). There are 260 Women Doctors(Regular and Contract basis) are serving totally (Source : Joint Director of Health Services, Tirunelveli, Deputy Director of Health, Tirunelveli ). Apart from them, various nursing homes, diagnostic centres and medical stores have their presence in the city to fulfil the need of all people. Tirunelveli District is the one of the Southern District in Tamil Nadu State.
The basic objective of the Health and Medical Department is to provide accessible, affordable and acceptable healthcare in rural and Urban areas. Health Infrastructure of Tirunelveli District consists of one Allopathy Medical College Hospital, one Siddha Hospital, one District Head Quarter Hospital, 6 Taluk Hospitals, 7 Non Taluk Hospitals, 69 Primary Health Centres and 383 Health Sub Centres. With the help of these Infrastructure Immunisation, Revised National Tuberculosis Control Program, Leprosy Eradication Program, National Vector Borne Disease Control Program Dr.Muthulakshmi Reddy Maternity Benefit Scheme , Palli Sirar Kannoli Kappom Thittam, Menstrual Hygiene Programme, Honorable Chief Minister Specialty Camp, Pallai Sirar Dental Health Programme and District Blindness Control Program activities are carried out successfully for the 30,72,880 population of this district.
7. Data Analysis And Interpretation
Table1: Demographic profile of the respondents
Variables Group No. of
Respondents Percentage Age in Years 25 – 30 74 61.6 31 - 45 27 22.5 46 - 60 19 15.8 Total 120 100 Marital Status Married 110 91.6 Unmarried 8 6.6 Widow / Divorcee 02 1.6 Total 120 100 Accommodation Home 95 79.1 Hostel 23 19.1 Temporary Arrangement 02 1.6 Total 120 100 Department Emergency Ward 30 25 General Ward 32 26.6 Critical Care 27 22.5 Paediatrics 06 5 Infectious Disease 17 14.1 Others 8 6.66
Total 120 100 Years of Experience Below 5 89 74.1 6 – 10 18 15 11 - 15 8 6.6 Above 15 05 4.1 Total 120 100 Working Hours / Day 10 hours 70 58.3 10 – 12 hours 33 27.5 Above 12 hours 17 14.1 Total 120 100 Night Duties / Week None 21 17.5 1 - 3 63 52.5 Above 3 36 30 Total 120 100
Source : Primary Data Table.1
According to Table-1 found that majority of the women Doctors were in the age group of 25-30 who constituted 61.6 percent of the total respondents and mostly they were all married who constituted 91.6 percent. 79.1 percent of the respondents were going to work from home only. Out of all the respondents, 25 percent were working in emergency ward, 26.6 percent were serving in general ward, 22.5 percent in critical care and 14.1 percent in infectious disease section, respectively. Majority of the respondents have below 5 years of experience who constituted 74.1 percent and only 4.1 percent of the respondents have more than 15 years of experience in the relevant field. 58.3 percent of the respondents were working for 10 hours daily. 52.5 percent of the respondents were working in night duties thrice a week and 17.5 were serving in night duties frequently.
Level of Perceived Stress:
The level of perceived stress of the sample respondents who have expressed their opinion on the Psychological Characteristics have been given here. The level of stress falls under three categories such as low, moderate and high.
Table 2: Level of Perceived stress
Level of stress Frequency Percentag
e
Low 8 6.6
Moderate 88 73.3
High 24 20
Total 120 100
Source : Primary Data Table .2
Table 2 shows that 73.3 percent of the respondents have moderate level of stress. 20 percent of the respondents have high level of perceived stress and 6.6 percent of the respondents have low level of stress.
Table 3: Scores and Garrett Ranks of perception of women Doctors towards the reason for Stress during COVID-19
This paper discussed about the garret ranking and its calculation methods. To find out the most significant factor which influences the respondent.
Percent Position = 100(Rij – 0.5) Nj
Where Rij = Rang given for the ith Variable by the jth respondents. Nj = Number of variable ranked by jth respondents
Rank Reasons Percentile
position
I Increased number of Patients treated for Covid-19 68.4
II Don’t have enough rest 47.63
III Lower logistics aid 44.75
IV Verbal or Physical violence of Patients 42.81
V Too much work allotted to me 40.07
VI Compromise of personal Safety 39
VII Personal Health Issue 37.63
VIII Relationship issue with my family 36.99
IX Isolation 33.26
X Increased average operating hours 28.56
Source: Primary Data Table-3
On the basis of the ranks assigned by the sample respondents, the reasons for stress during COVID-19 are analyzed through Garrett Ranking Techniques. It is evident from above table, it reveals that the Increased number of Patients treated for Covid-19 (68.4) was the main reason for stress, followed by Don’t have enough rest (47.63), Lower logistics aid (44.75), Verbal or Physical violence of Patients (42.81), Too much work allotted to me (40.07) , Due to Compromise of My personel safety (39), Personal Health Issue (37.63), Relationship with my family(36.99) Isolation (33.26) and Increased average operation hours (28.56).
8. Conclusion
The country has registered over 1,28,01,785 confirmed cases and 1,66,177 deaths as of 7th April 2021 (Ministry of Health and Family Welfare, Govt. of India, 2021). A large number of front-line doctors have also fallen victim to COVID-19 as a global trend. The government was swift to put in place restrictions around national transit points in order to reduce the transmission of the virus and introduced stringent measures, including a complete national shutdown and forced social distancing. As a result, there are extensive complications, travel restrictions, difficulties in buying essential products and obtaining other crucial services (e.g. transport, health care, etc.) around the country. During the COVID-19 epidemic, the women Doctors involved were under great psychological pressure and were more stressed and poor work-life balance adversely affected the well being of the doctors. Women Doctors should be screened for psychological problems as part of the emergency epidemic prevention and control system, and appropriate interventions should be implemented as soon as possible during the epidemic. Special interventions to promote mental well-being in health care workers exposed to COVID-19 need to be immediately implemented, with women Doctors requiring particular attention.
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