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.