Mental health condition of physicians working frontline with COVID-19 patients in Bangladesh

Currently the world is facing a “global disaster” called Corona Virus Disease 2019 (COVID-19) for which many countries are in a stage of “epidemiological emergency” [1]. There have been 131,487,572 positive cases confirmed as well as 2,857,702 deaths reported until 7 April, 2021, making this pandemic spread across 213 countries [2]. Bangladesh has reported approximately 1,000,543 confirmed positive cases along with 16,004 deaths so far in this pandemic, which began on 8 July, 2021 [3]. According to different projections, this number of death cases may cross 41 million throughout the world by 23 July, 2021 [4]. This pandemic has created unanticipated disarray in the global health system since the global health governance has not responded adequately during the COVID-19 outbreak [5]. The disease spread rapidly across the globe due to some unique properties of the virus (highly contagious, frequent mutations, easy mode of transmission, relatively unaffected by climatic variations) [6]. During any uncertain situation it is common for an individual to feel anxious, out of control, bewildered, etc. [7]. So during this crisis period, individuals are expected to encounter several mental health challenges ranging from panic attacks, phobia, anxiety, depression, sleep disturbances to dissociative like symptoms [8]. Fortunately, most people have the option to keep themselves safe through maintaining social distancing and other preventive measures. However, the healthcare professionals, especially physicians working in the frontline have an increased risk of getting infected by COVID-19 as they so not have the opportunities to work from home [9]. They treat the patients with confirmed and or suspected COVID-19 on a daily basis. Some have to stay separated from families due to self-quarantine after their hospital duties. As a result, preliminary research among physicians demonstrated that they are suffering from fear of being stigmatised and various stress reactions [10]. Lower middle-income countries have higher burden of mental disorders than economically developed countries in the normal situation, which could be worsened by COVID-19 situation [10‐12].

In a densely populated and resource constrained setting like Bangladesh, the health systems are coping with the pandemic with several limitations. Similar to other countries, physician belong to the most vulnerable groups to be infected by this contagious virus. Bangladesh was identified as one of the countries with highest physician’ mortality in the crisis (4%) [13]. According to a published report by Bangladesh Medical Association (BMA), on 25 July 2021, more than 3058 physicians were infected with COVID-19 and 172 have passed away due to complications [14]. Such facts reflect the vulnerable situation of the physicians in the country. If the physicians’ mental condition is affected, it may hamper the service delivery to the community during this crisis period.

Mental disorders are generally not perceived as serious health problems and are not within the priorities in the health care delivery system in resource-poor settings like Bangladesh. Moreover there is chance of being stigmatised if someone reveals the news of having any mental diseases [10]. Study suggest that mental disorder with co-morbidities may reduce life expectancy by about 20 years [15]. So, to ensure continuity of medical services, maintaining the mental health wellbeing of these front liners should be the top priority of medical authorities. To support the physician’s community, it is imperative to understand the mental health status of Bangladeshi physicians in this ongoing COVID-19 crisis. Till date, there is scarcity of reliable information on the mental health of Bangladeshi physicians with an appropriate sample size [16‐18]. So, we have designed a quick survey, with a cross sectional study design and distributed this among physicians of Bangladesh to assess their mental health status that might be helpful to the policy makers to intervene in appropriate manner at this current COVID-19 period.

In the recent years, prevalence of mental health conditions among the physicians has been observed to be higher compared to the general population under similar circumstances [28]. Unfortunately, the current COVID-19 circumstances have proved to be a catalyst in further deterioration the mental health status of the health care professionals [10].

Hence, in line with the above statement, the findings in the current study reveal that between 35% and 55% of the physicians were found to develop depression, anxiety and stress. Also, the study showed that around 20% of physicians had severe form of depression, anxiety and stress. Depression was more prevalent than anxiety and stress during the COVID-19 pandemic, as was found in other studies in Bangladesh and Middle East [29‐31]. On the other hand, in China, where this pandemic started, anxiety was the leading mental health condition among the physicians [32]. In South Asian countries, slight differences were found between the prevalence of anxiety, depression and stress. In Bangladesh anxiety was more prevalent than depressive symptoms with a difference of huge margin [31, 33, 34]. Most of the participants of our study were young and manifestation of depression in these young physicians more than other feelings, like anxiety and stress, indicates that dealing with this highly infectious disease created feelings of uncertainty around progression in life and future during and beyond this unprecedented situation of the pandemic. Well-trained physicians were better able to cope with the situation. The differences with findings of other studies can be explained by differences in research methodology. In another study conducted in Bangladesh among COVID-19 patients found 56%-87% proportion of depression and anxiety [35].

The study findings denoted that, the mental health of physicians was deeply affected by the pandemic. Availability of appropriate mental health support will help to foster resilience by giving them the ability and confidence to manage stressors in crisis moments like COVID-19. It is an interesting finding of our study has demonstrated that heightened depression in younger physicians compared to the older physicians and it needs to be explored further to understand the reasons to take policy action.