Abstract
Healthcare workers (HCWs) on the frontline of the COVID-19 pandemic who were
directly involved in the diagnosis, treatment and care of patients with COVID-19 were at
risk of developing psychological distress and other mental health symptoms. To date,
epidemiological data on the mental health issues of those suspected of having or
diagnosed with COVID-19, and their treating health professionals, in South Africa is very
limited. Hence, it was vital for this research to be carried out, so that mental health
symptoms among HCWs during the pandemic could be assessed, and so that
psychosocial support structures in place for HCWs in South Africa can be considered.
The overall aim of this study was to assess mental health symptoms among HCWs
treating patients exposed to COVID-19 in Gauteng, South Africa. The specific objectives
of the study were to assess the presence and severity of symptoms of depression,
anxiety and insomnia of HCWs exposed to COVID-19, by using the Patient Health
Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7- (GAD-7) and the
Insomnia Severity Index-7 (ISI-7), to determine the relationship between mental health
symptoms of HCWs and their sector of employment (private or public); to examine the
current workplace psychosocial support systems in place to support HCWs at the
frontline of the COVID-19 pandemic, and to determine the relationship between
workplace psychosocial support systems for HCWs and their sector of employment
(private or public).
The study was conducted in the Inner City and Johannesburg South regions (Region F)
of Gauteng, South Africa in May 2021. A total of 234 frontline HCWs (specifically doctors
and nurses) from private general practitioner (GP) practices, private hospitals and 13
public healthcare facilities participated in the study. All the participants completed a
questionnaire enquiring about their socio-demographic characteristics and mental
health symptoms. A total of 234 out of 260 contacted individuals completed the survey,
thus a participation rate of 90%. Of the 234 HCWs who participated in the study, 190
(81.2%) were female, and 44 (18.8%) were male. The participants were aged between
36 and 45 years (79 [33.8%]), were unmarried (105 [44.9%]) and had a tertiary
education (217 [92.7%]). All 234 participants (100%) were frontline healthcare workers
who were directly engaged in diagnosing, treating or caring for patients with or
suspected of having COVID-19. The majority of the participants worked in the public
sector (151 [64.5%]), while 83 participants (35.5%) worked in the private sector. The
v
results showed that a considerable proportion of HCWs reported symptoms of
depression (102 [43.6%]), anxiety (105 [44.9%]) and insomnia (70 [29.9%]). It was also
found that there were no significant differences in symptoms of depression (X2=4.8,
p>0.05), anxiety (X2=0.8, p>0.05) and insomnia (X2=2.1, p>0.05) between public and
private sector HCWs. In evaluating the current psychosocial support systems in place
for HCWs, the results showed that 49.1% of the participants indicated that psychological
services did exist in their place of work, and 50.9% said they did not exist. Perceptions
that psychological services existed were more common among HCWs in private
healthcare facilities (66.3%) than among HCWs in public healthcare facilities (39.7%).
However, many of the respondents noted that these services are insufficient or invisible,
in both the private and the public sectors, and this emerged as the main theme based
on the responses of the HCWs.
The current study identified the prevalence of depression, anxiety and insomnia among
HCWs in Gauteng, South Africa, and it also highlighted the differences between private
and public sector HCWs in perceptions of the psychosocial support systems that exist
in the region. Psychosocial support systems such as mental health counselling, support
groups, psychological services and employee assistance programmes were identified
as some of the key services or interventional measures that need to be explored and
implemented for HCWs. Mitigating strategies specific to South African HCWs are
urgently needed to help them cope with mental health symptoms beyond the pandemic.
This study presents a case for improving mental health services provided to HCWs,
given the perceived inadequacies that were shown. Considering the frequency of mental
health symptoms occurring in HCWs, accompanying mental health-informed
interventions to facilitate coping are necessary. Protecting the mental health and wellbeing
of HCWs is therefore paramount during an infectious disease outbreak.