The Impact of COVID-19 on Mental Health
Surgeons and trainee doctors from various surgical disciplines have been
redeployed to cover on COVID wards and work in the frontline in hotspot
areas to help cope with rising demands attributed to the surge in
patients. The stress of having to step out of the comfort zone of usual
practice into a high-risk unfamiliar environment at a short notice can
be overwhelming, as demonstrated by Lai et al where 70% and 50% of
1257 healthcare workers (40% frontline professionals) in China reported
symptoms of distress and depression respectively.10
Similarly, Liang et al assessed the mental health status of 59 staff
associated with COVID departments and other related departments at the
Fifth Affiliated Hospital of Sun Yat-sen University using Zung’s
self-rating depression scale (SDS) and self-rating anxiety scale
(SAS).11 Although statistically insignificant, younger
staff members (≤ 30 years of age) were found to have higher SDS scores.
Huang et al conducted a similar assessment of the mental health of
frontline clinicians in China.12 Across 230 responses,
the prevalence of anxiety and stress disorders were 23% and 27%
respectively; with higher incidence of SAS scores and stress disorders
among female clinicians.12 On a larger scale, Lv et al
found an incidence rate of 34.7% overall anxiety and 24.8% of mild
anxiety across 8028 surveyed doctors and nurses on the
frontline.13
Further to this, Kang et al. explored the impact of mental health and
coping strategies of Wuhan medical personnel between January 29th and
February 4th 2020.14 Employing mental health measures
for depression (Patient Health Questionnaire-9; PHQ-9), anxiety
(Generalised Anxiety Disorder-7; GAD-7) and distress symptoms (Impact of
Events Scale-Revised; IES-R) - a cohort of 994 staff responded to the
study. Statistically significant results revealed mental health
disturbances were prevalent across all participants for the three
outcome measures. Individuals reported to be symptomatic across the
sub-threshold (36%), mild (34.4%), moderate (22.4%) and severe
(6.2%) levels. Pivotally, coping strategies were varied across all
participants ranging from perusing psychological resources (36.3%),
50.4% accessing digital psychological recommendations (36.3%) and
participating in therapeutic support (17.5%). Individuals who
experienced severe disturbances were less likely to access psychological
materials or online mental health guidance. These aforementioned studies
not only highlight the necessity for greater and earlier support, but
also the versatility of resources that should be provided and promoted
to frontline clinicians.
Finally, importance should be given to the social and practical factors
associated with living through the social-isolation response to the
pandemic. Several facets are adversely impacted inclusive of
socialisation with friends and family, regular engagement in leisure
activities and procurement of sustenance and other essential items.
Fundamentally, there is a detrimental impact on the freedom of movement
and a risk of increased anxiety about the health and safety of friends
and family. These factors consolidated, may affect the surgeon’s ability
to manage stress on a daily basis. As normal service resumes in clinics,
there is a potential that there could be a surge in referrals of the
“worried well” group, leading to increased demand on services and
further work stress.