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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 4  |  Page : 245-250

Perceived stress and coping strategies among junior doctors during the COVID-19 pandemic: A cross-sectional study in a tertiary care hospital, West Bengal


Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

Date of Submission03-May-2022
Date of Decision22-May-2022
Date of Acceptance23-May-2022
Date of Web Publication27-Oct-2022

Correspondence Address:
Sukesh Das
Assistant Professor, Eden Horizon, Block 1, Flat 3A, 963 Uttar Purba Fartabad, South 24 Parganas, P. O. Garia, Kolkata 700 084, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcsr.jcsr_83_22

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  Abstract 


Background: The severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) disease (COVID-19) pandemic has put frontline health-care workers into unprecedented amounts of difficulty and psychological stress.
Methods: In this cross-sectional, analytical study 122 junior doctors (interns, house staffs and postgraduate trainee) of a tertiary care hospital in West Bengal were studied during the period November 2021–January 2022. Data were collected using an online structured questionnaire, prepared as Google Forms and shared by WhatsApp. The Perceived Stress Scale (PSS-10) was used for the study. Information regarding various coping strategies adopted in the past 1 month was also collected.
Results: High prevalence (83.7%) of moderate-to-high stress was observed among junior doctors (mean PSS score 21±6.9). Multivariable analysis showed female gender, single (unmarried) status and separation from family during COVID duty assignment were significantly at risk of moderate-to-high stress. The coping behaviours commonly used by the study participants were physical exercise, sharing feelings, talk therapy, meditation, hoping for the best, faith in God/religion, watching movies etc., with many struggling to cope.
Conclusions: High prevalence of moderate-to-high stress and difficulty in coping were observed among the junior doctors. It's the need of the hour to plan support programmes dedicated to junior doctors emphasizing coping strategies and stress management.

Keywords: COVID-19, pandemics, psychological, stress


How to cite this article:
Ghosh S, Bandyopadhyay K, Das S. Perceived stress and coping strategies among junior doctors during the COVID-19 pandemic: A cross-sectional study in a tertiary care hospital, West Bengal. J Clin Sci Res 2022;11:245-50

How to cite this URL:
Ghosh S, Bandyopadhyay K, Das S. Perceived stress and coping strategies among junior doctors during the COVID-19 pandemic: A cross-sectional study in a tertiary care hospital, West Bengal. J Clin Sci Res [serial online] 2022 [cited 2022 Dec 7];11:245-50. Available from: https://www.jcsr.co.in/text.asp?2022/11/4/245/357863




  Introduction Top


The severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) disease (COVID-19) pandemic is the defining global health crisis of our time and the greatest challenge after World War II.[1] Health facilities worldwide were unprepared for this catastrophe; the sudden surge of cases and lack of scientifically proven treatment strategies have exposed an already tenuous overburdened health infrastructure. As a result, many doctors have been redeployed to areas outside their usual clinical specialty and/or expertise, often working extra shifts and longer hours to meet high volume patient demand.[2] SARS-CoV-2 being highly infectious, doctors have the highest risk for acquiring the infection and potentially transmitting it to patients, co-workers, family members and friends. As a result of this, health-care workers faced unprecedented amounts of COVID-19-related psychological stress across professional and personal domains and its' consequences.[2] Coping with the crisis is a real challenge. Coping represents the thoughts and actions that individuals use to deal with stressful events.[3] The use of coping strategies results in lower levels of stress.[4]

Barring a few studies, the mental health of junior doctors affected by the COVID-19 pandemic has been largely under addressed in this part of India although they are the backbone of the tertiary healthcare system. With this backdrop, the present study was conducted to find out the level and correlates of psychological stress among the junior doctors, as well as their coping strategies in the context of the ongoing COVID-19 pandemic in a tertiary care hospital in West Bengal.


  Material and Methods Top


The study was initiated after obtaining approval from the Institutional Ethics Committee of the College of Medicine and Sagore Dutta Hospital. Voluntary participation as well as anonymity and confidentiality of the collected information were ensured.

It was an observational analytical study, with a cross-sectional design. The study was carried out among junior doctors (intern, house staff and postgraduate trainee doctors [PGTs]) working in the COVID-19 wards in the College of Medicine and Sagore Dutta hospital, Kolkata, West Bengal. House staffs were those doctors who after completion of internship, worked in particular departments. The study duration was 3 months (November 2021–January 2022). The junior doctors, as mentioned above, who were working in COVID wards for at least 1 month, were selected for this study excluding those who refused to participate in the study.

Taking reference from a similar study[5] where the prevalence of moderate and high stress among medical professionals was 81.7%, and taking absolute precision as 5%, and using finite population correction, the minimum sample size for this study was 107. Considering high non-response rate for online survey, as 30%[6] the sample size estimated as 140 (107 + 33). Out of the total 196 junior doctors of the above-mentioned hospital, 140 were selected by simple random sampling and were approached for this study. Six of them refused to participate in the study, so excluded. The questionnaire was shared to 134 junior doctors, 12 of them did not submit the filled-up forms, so the final sample size for this study was 122.

An online structured questionnaire was prepared on the Google Forms platform comprising questions on sociodemographic characteristics, clinical work environment, family concerns, Perceived Stress Scale (PSS-10) and various coping strategies adopted in the past 1 month. The PSS, one of the most widely used psychological instruments for measuring the perception of stress over the past 4 weeks, was used in this study.[7] The range of scores and interpretation in this scale is 0–13: low stress, 14–26: moderate stress and 27–40: high stress. Study participants were asked about the various coping strategies they were engaged in the past 1 month. The link of online questionnaire prepared on the Google Forms platform was shared among the junior doctors through WhatsApp, ensuring that all of them using WhatsApp. They were requested to fill up the questionnaire completely and submit it within 1 month. The reminder was sent thrice to the participants to fill up the form. After clicking on the link, a participant was auto-directed to the purpose and procedure about the study and the informed consent. Only after agreeing to the informed consent, set of questions appeared sequentially.

Statistical analysis

Data were entered into Excel spreadsheet (Microsoft Corp, Redmond, WA). Data were analysed using frequencies, percentages, odds ratio (OR), adjusted odds ratio (AOR) binary logistic regression. Statistical Package for the Social Sciences (SPSS) Version 20.0 (IBM Corp. Somers NY, USA) was used for data analysis.


  Results Top


Out of 122 junior doctors, 54.1% were male while the rest i.e., 45.9% were female. The majority of the study participants (83.1%) were within 25 years of age with mean age 25.6±4.1 years. About four-fifths of the study participants had sleep disturbances in the past 1 month, while 97.5% of them feared about transmitting COVID-19 to family members [Table 1].
Table 1: Distribution of the study participants according to sociodemographic variables, behavioural characteristics and clinical work environment (n=122)

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Regarding PSS, 64.2% of the respondents had moderate stress while 19.5% experienced high stress. Among the different categories of junior doctors, moderate-to-severe stress was most common in the interns (85.3%) followed by PGTs (84%) [Table 2].
Table 2: Perceived Stress Scale-10 score among different categories of the study participants (n=122)

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Bivariate analysis showed that female gender (OR 6.13, 1.69–22.21), single (unmarried) status (OR 5.82, 1.08–31.28), on-call duty (OR 9.09, 1.22–100.00) and separation from family during COVID duty assignment (OR 4.20, 1.55–11.36) were at risk for moderate-to-high stress among the study participants. By multivariate analysis (binary logistic regression), female gender (AOR 7.94, P = 0.02), single (unmarried) status (AOR 129.44, P =0.01) and separation from family during COVID duty assignment (AOR 6.89, P =0.01) were significantly at risk of moderate-to-high stress [Table 3].
Table 3: Correlates of stress among the study participants (n=122)

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The current study found “hoping for the best” was the most commonly (72.1%) used coping mechanism, followed by “faith in God/Religion” (68.8%). Around half of the participants coped through physical activity, sharing feelings and talking about different things (talk therapy); meditation, watching movies and avoiding thinking about the current stressful situation were other coping behaviours [Table 4].
Table 4: Distribution of study participants according to coping strategies adopted in the past 1 month (n=122)

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  Discussion Top


Similar to the PSS score of 20.97 (6.85) observed in the present study, a study[5] from North India reported it as 19.31 (6.39) among resident doctors and another study[8] from West Bengal found it as 20.14 (5.23) among health professionals. The above mentioned study[8] from North India found that 66.5% and 15.2% of resident doctors experienced moderate and high stress, respectively, similar to the findings of the present study of 64.2% and 19.5%, respectively.[5] Another nationwide study[9] among health professionals in India during the COVID-19 pandemic showed that 78.9% of study participants suffered from moderate stress and 3.7% had a high level of stress. In the current study, moderate-to-high stress was present in 85.3% of interns which is quite higher than a study[10] in South India, which reported this as 55.3%. In the same study, 66.7% of resident doctors were found having moderate-to-severe stress compared to the present study which found higher prevalence i.e., 84% among PGTs for the same.[10] Hence, this establishes the fact that junior doctors were at the receiving end of stress due to this pandemic.

In this study, female doctors (94.6%) had more moderate-to-high stress compared to male respondents (74.2%) which was statistically significant (AOR = 7.94, P = 0.02), similar to studies from West Bengal and Wuhan, China.[8],[11] Another nationwide study in India also suggested that women health professionals were at approximately two times higher odds to develop stress, depression and anxiety compared to male counterparts.[9] In the present study, almost all of the participants feared of transmitting COVID-19 infection to family members, contributing to increased stress. Several studies from different parts of the world also pointed out that among health-care workers (HCWs), female gender, worry of family members, or themselves getting infected were associated with mental health problems.[12]

The observation in the present study that moderate-to-high stress was more prevalent among respondents involved in on-call duty compared to floor duty, can be explained as the resident doctors involved in on-call were more involved in close contacts with COVID patients such as systemic examinations, critical interventions such as aerosol-generating procedures in high dependency units, critical care units etc., Similar findings were reported by a study[13] from New York where advanced caregivers (resident doctors) screened for acute stress significantly more likely (64%) than the rest of the physicians (40%). It is observed in this study that doctors in single relationship status compared to married ones were at risk of moderate-to-severe stress (AOR = 129.44, P = 0.01). It is plausible that unmarried/single respondents found themselves lonely, isolated during this pandemic. Contrary to this, a study in Italy showed no differences on perceived stress among health professionals according to marital status.[4] Similar to the present study, another study[8] from West Bengal reported that among health professionals, higher PSS scores were seen in those who were single, interns/house staff, those working in COVID-19-positive wards, those working longer hours (≥6 h/day).

Avoiding interpersonal contact (social distancing) is considered an important measure to tackle the infective outbreak, greatly practised in the ongoing COVID-19.[14] As a result, HCWs were mandated to maintain distance from their colleagues, both at the workplace and outside, which deprived them of otherwise much-needed social support. Further, maintaining social distancing from their family members (including avoiding sharing beds with one's partner) results in a lack of emotional support from the significant others and adds to emotional stress and mental health problems.[15] The present study showed that separation from family members during COVID duty assignment has also been significantly related to moderate-to-severe stress (AOR = 6.89, P = 0.01). COVID-19 being highly infectious, HCWs have higher risk of getting infected and also transmitting the infection to friends and family members. Due to this, many of them stayed away from their family for several months which contributed to stress and/or other mental health problems. The study[8] from West Bengal although reported higher PSS score among those staying with family and the association was found statistically significant. This finding may be explained by the apprehension among the health professionals regarding the potential risk of transmission to the family members. In a study[13] three-fourths of health-care workers were highly distressed by fears about transmitting COVID-19 to family or friends and two-thirds (64%) were highly distressed by having to maintain social distance from family.

It is known that people use various coping methods in crisis or disaster situations, as observed in this study.[16] In consistent with the current study, other studies reported several coping mechanisms among doctors during this pandemic.[5],[13],[14],[16] A study[14] from South India reported listening to/playing music, practicing yoga/meditation, playing sports, reading, smoking, watching movies and reading as coping behaviours to alleviate stress by interns and resident doctors. A study[16] from the United Kingdom reported hoping for the best, remaining busy in activities, problem-solving, sharing feelings, and talking to others as coping strategies among medical professionals during the COVID-19 pandemic, quite similar to the present study. Moreover, a study[13] from New York found physical exercise as the most common coping behaviour (59%), followed by engaging with talk therapy (26%), faith-based religion and/or spirituality (23%), yoga (25%), meditation (23%) and virtual provider support groups (16%). Another study from North India reported recreational activities such as working out in gymnasium, reading books, watching movies/pornography, surfing Internet, listening to music, chatting with friends and chatting on social media among health professionals during this pandemic.[5] The present study also highlighted that about two-fifths of the participants struggled to cope in this stressful situation which is echoed by the study from South India which reported unable to cope or unhealthy coping mechanisms among sizeable proportion of junior doctors.[14] The UK-based survey[16] also observed struggling to cope among HCWs. Thus, this study measured the level of stress among junior doctors in a setup that encountered a huge caseload, thereby having implication for resource-poor nations like India. Second, it came up with context-specific correlates of stress that are amenable to intervention. As all of the study participants were fully vaccinated, it (i.e. vaccination status) was not included as correlate of stress in this study. Furthermore, it identified many of the participants unable to cope. This study is not without limitations, although, namely as it is based on a single tertiary care hospital, the findings lack generalisability. Furthermore, it would have been more robust if the association of coping strategies with the level of stress could be shown. Measures related to the physical health of the junior doctors such as enhancing body immunity would be pertinent in future research.

The current study observed a high prevalence of stress and it's correlates among the frontline HCWs i.e., junior doctors. Considering the above perspectives, it is the need of the hour to plan support programmes specifically dedicated to junior doctors emphasizing coping strategies and stress management, which will be helpful to deal with extremely stressful events and possible future epidemics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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