CORRESPONDENCE

 

Personal and occupational experiences of COVID-19 and their effects on South African health workers' wellbeing

 

 

To the Editor: COVID-19-related psychological stressors and health risks among health workers are increasingly reported, particularly among those who are hospital based and are directly responsible for caring for patients with COVID-19.^[1-4] We report findings from an online survey conducted between September and November 2020 in the Amajuba District of KwaZulu-Natal, reflecting experiences of the first COVID-19 wave. It investigated risk factors for severe COVID-19, experience of COVID-19-related problems, causes of anxiety, and effects on psychological wellbeing. The survey was completed as part of an intervention intended to support primary care workers in managing COVID-19 in the context of a high tuberculosis burden, and to address their psychological wellbeing.

All Department of Health employees in Amajuba were invited to participate. Of 450 who responded, 53% were clinically practising nurses or nursing assistants, 12% operational managers or co-ordinators, 19% non-clinical support staff and 15% in other job categories; 83% worked in primary care, 14% in hospitals and 3% in the district office.

Eleven percent of respondents were aged >55 years, 6% reported having diabetes, and 9% reported obesity; 22% of all respondents, including 45% of managers, reported having one or more of these risk factors for severe COVID-19.

Twenty-two percent of respondents reported having tested positive for COVID-19, 2% had been hospitalised for COVID-19, 20% had quarantined because they had close contact with someone who tested positive, 35% had a relative or friend who tested positive, 9% had a relative or friend who was hospitalised for COVID-19, and 14% had a relative or friend who died due to COVID-19; 74% reported at least one of these experiences.

Personal experiences of COVID-19 were associated with worse mental health, measured with the General Health Questionnaire 12 (GHQ12).^[5,6] The GHQ score was calculated from responses, on a Likert scale, to 12 questions about concentration, lost sleep, feeling useful, ability to make decisions, strain, difficulties, enjoyment, ability to face problems, losing confidence, feeling worthless, unhappiness and happiness. In a linear regression model, higher GHQ12 scores, indicating worse mental health, were statistically significant (p<0.05) and independently associated with reporting testing positive for COVID-19, having quarantined as a close contact of someone who tested positive, a relative or friend testing positive, a relative or friend dying due to COVID-19, and being a manager, but not with age or gender.

Anxiety about COVID-19 was assessed using 15 statements we developed, informed by our work on health workers' concerns about COVID-19 (Table 1). The most common worries were about infection at work (78%) and infecting household members (84%), and most respondents worried about the effects of COVID-19 on their own and their families' health, and the stresses of managing COVID-19 clinically.

This study highlights adverse effects of COVID-19 on health workers' wellbeing in a diverse, mostly primary care-based workforce. Worries and personal experiences of COVID-19 were common and associated with worse mental health. Managers were most at risk of severe COVID-19 and had worse GHQ12 scores; non-clinical support staff were also affected. With the active roll-out of the COVID-19 vaccine for health workers currently underway,^[7] it is hoped that health workers' anxieties regarding the risk of infection at work and passing it to loved ones will be mitigated. However, the effects of sustained work pressure and anxiety on the mental wellbeing of health workers remain. These findings reinforce the urgent need for psychosocial support for all healthcare workers, including managers and clinical and non-clinical staff. Support for managers is particularly emphasised given the role that containing leadership plays in reducing anxiety in times of crisis.^[8]

Acknowledgements. We thank the study participants, the Amajuba District team, and the KwaZulu-Natal Department of Health for agreeing to and facilitating this study.

Funding. This research was funded by the National Institute for Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King's College London (GHRU 16/136/54) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Robyn Curran

Knowledge Translation Unit, University of Cape Town Lung Institute, Faculty of Health Sciences, University of Cape Town, South Africa robyn.curran@uct.ac.za

Max Bachmann

Norwich Medical School, University of East Anglia, Norwich, UK

André J van Rensburg

Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Jamie Murdoch

School of Health Sciences, University of East Anglia, Norwich, UK

Ajibola Awotiwon, Christy-Joy Ras

Knowledge Translation Unit, University of Cape Town Lung Institute, Faculty of Health Sciences, University of Cape Town, South Africa

Inge Petersen

Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

Lara Fairall

King's Global Health Institute, King's College London, UK; and Knowledge Translation Unit, University of Cape Town Lung Institute, Faculty of Health Sciences, University of Cape Town, South Africa

 

References

1. Naidoo I, Mabaso M, Moshabela M, Sewpaul R, Reddy SP. South African health professionals' state of well-being during the emergence of COVID-19. S Afr Med J 2020;110(10):956. https://doi.org/10.7196/SAMJ.2020.v110i10.15250        [ Links ]

2. Chersich MF, Gray G, Fairlie L, et al COVID-19 in Africa: Care and protection for frontline healthcare workers. Global Health 2020;16:46. https://doi.org/10.1186/s12992-020-00574-3        [ Links ]

3. Muller AE, Hafstad EV, Himmels JPW, et al. The mental health impact of the COVID-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Res 2020393:113441. https://doi.org/10.1016/j.psychres.2020.113441        [ Links ]

4. Tsamakis K, Rizos E, Manolis AJ, et al. COVID-19 pandemic and its impact on mental health of healthcare professionals. Exp Ther Med 2020;19(6):3451-3453. https://doi.org/10.3892/etm.2020.8646        [ Links ]

5. Jackson, C. The General Health Questionnaire. Occup Med 2006;57(1):79. https://doi.org/10.1093/occmed/kql169        [ Links ]

6. John VM. Use of the General Health Questionnaire (GHQ) in a Zulu-speaking setting: An assessment of translation, reliability and some validity issues. ResearchSpace, 1996. https://researchspace.ukzn.ac.za/xmlui/handle/10413/5968 (accessed 16 March 2021).         [ Links ]

7. Mlambo S. Over 128 000 health workers vaccinated, 1477 new infections and 109 Covid-19 deaths. IOL, 11 March 2021. https://www.iolcoza/news/south-africa/over-128-000-health-workers-vaccinated-1477-new-infections-and-109-covid-19-deaths-bc2c3af9-7872-457f-a432-0402c2ae3369 (accessed 16 March 2021).         [ Links ]

8. Hobfoll SE, Watson P, Bell CC, et al. Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry 2007;70(4):283-315; discussion 316-269. https://doi.org/10.1521/psyc.2007.70.4.283        [ Links ]