Assessment of Mental Health in Healthcare Workers Exposed to COVID-19 Patients

Coronaviruses belong to a large family of viruses, responsible for causing mild respiratory
infections such as the common cold or severe syndromes such as the Middle East Respiratory
Syndrome (MERS) or Severe Acute Respiratory Syndrome (SARS). A novel coronavirus named severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the most recent
disease outbreak called COVID-19 that originated in Wuhan, China in December 2019. The
outbreak rapidly spread to other parts of China and the world, including Qatar. As of 4th
March 2020, the total number of confirmed cases in Qatar is 1325 and worldwide is 1,169,262.
On 11 March 2020, the World Health Organization had declared COVID-19 as a global pandemic.

The health care workers are on the frontline providing routine and essential services to the
COVID-19 patients, including diagnosis, treatment, and care. Consequently, these individuals
are at a high risk of developing and experiencing psychological distress. Considering the
continuously increasing suspected and confirmed COVID-19 cases, lack of specific treatment,
inadequate personal protective equipment and the need for meticulous nursing care, the health
care workers are overburdened mentally and are prone to mental illnesses. Not to mention, the
risk of themselves getting infected due to direct exposure to patients and subsequent
self-isolation they must undertake to prevent the spread to their own families, contribute to
their mental burden. Undoubtedly, health care workers are working in a stressful environment
that makes them susceptible to burnout syndrome, anxiety, depression, and stress (BADS).
Burnout syndrome itself can cause emotional instability, feeling of failure, difficulty in
making commitments, and an urge to resign (Maslach et al. 2001).

Several studies reported the psychological impact of the 2003 SARS outbreak among health care
workers. The hospital staff experienced the fear of contagion and of spreading the infection
to their own family, friends, and co-workers (Maunder et al. 2003, Nickell et al. 2004).
Stigmatization and uncertainty were prominent among these individuals (Maunder et al. 2003,
Bai et al. 2004). A recent study by Lai et al. (2019) assessing the mental health outcomes of
health care workers exposed to COVID-19 patients in Wuhan, China showed that these
individuals reported symptoms of anxiety, depression, distress, and insomnia. Notably, these
symptoms were adversely severe in nurses and frontline health care workers in comparison to
other health care workers. These studies highlight the psychosocial morbidity of disease
outbreaks and stress on the need for assessing the psychosocial impact of COVID-19 on health
care workers. Furthermore, conducting longitudinal studies are also essential to determine
the long-term psychological impact of such outbreaks on health care workers and to identify
factors that increase their vulnerability. Such studies will also allow us to assess and
develop coping strategies and effective psychosocial support programs to prepare the health
care workers for challenges produced by future outbreaks of such nature.

The current study aims to evaluate the mental health outcomes of healthcare workers who are
on the frontline of dealing with COVID-19 patients compared to non-COVID-19 patients. We aim
to assess the magnitude of symptoms of burnout, depression, anxiety, stress (BADS) and the
vulnerability to post-traumatic stress disorder (PTSD) by using established survey-based
tools during and after the COVID-19 crisis and performing statistical analysis of the data
obtained. The participants include healthcare staff working with COVID-19 patients and those
not working with COVID-19 patients as controls, inside and outside Qatar. The study is also
expected to be extended internally to assess the psychological impact globally. This study is
highly relevant and significant considering previous reports of psychological morbidity of
disease outbreaks. It will allow the development of special interventions to provide
psychosocial support to the health care workers that would need to be implemented
immediately.