Perceived risk and distress related to COVID-19 in healthcare versus non-healthcare workers of Pakistan: a cross-sectional study

(2022) 20:11 Abid et al. Human Resources for Health https://doi.org/10.1186/s12960-022-00705-4 Open Access RESEARCH Perceived risk and distress related to COVID‑19 in healthcare versus non‑healthcare workers of Pakistan: a cross‑sectional study Adeel Abid1†, Hania Shahzad1†, Hyder Ali Khan2, Suneel Piryani2, Areeba Raza Khan3 and Fauziah Rabbani2,3* Abstract Background: Healthcare workers (HCWs) have found themselves and their families more susceptible to contracting COVID-19. This puts them at a higher risk of psychological distress, which may compromise patient care. In this study, we aim to explore the risk perceptions and psychological distress between HCWs and non-healthcare workers (NHCWs) in Pakistan. Methods: A cross-sectional study was conducted using an online self-administered questionnaire. Psychological distress was assessed through The Hospital Anxiety and Depression Scale (HADS). Comparisons were made between HCWs (front/backend, students/graduates) and NHCWs related to risk perceptions and stress levels related to COVID19. Following tests for normality (Shapiro–Wilk test), variables that fulfilled the normality assumption were compared using the independent samples t-test, while for other variables Mann–Whitney U-test was employed. Pearson Chisquare test was used to compare categorical data. Multiple logistic regression techniques examined the association of participant age, gender, household income, and the presence of COVID-19 symptoms with depression and anxiety levels. Results: Data from 1406 respondents (507 HCWs and 899 NHCWs) were analyzed. No significant difference was observed between HCWs and NHCWs’ perception of susceptibility and severity towards COVID-19. While healthcare graduates perceived themselves (80% graduates vs 66% students, p-value 0.011) and their family (82% graduates vs 67% students, p-value 0.008) to be more susceptible to COVID-19, they were less likely to experience depression than students. Frontline HCWs involved in direct patient care perceived themselves (83% frontline vs. 70% backend, p-value 0.003) and their family (84% frontline vs. 72% backend, p-value 0.006) as more susceptible to COVID-19 than backend healthcare professionals. Over half of the respondents were anxious (54% HCWs and 55% NHCWs). Female gender, younger age, lower income, and having COVID-19 related symptoms had a significant effect on the anxiety levels of both HCWs and NHCWs. Conclusion: Frontline HCWs, young people, women, and individuals with lower income were at a higher risk of psychological distress due to the pandemic. Government policies should thus be directed at ensuring the mental *Correspondence: † Adeel Abid and Hania Shahzad contributed equally to this work 2 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Abid et al. Human Resources for Health (2022) 20:11 Page 2 of 13 well-being of frontline HCWs and improving their satisfaction to strengthen the health care delivery system. The findings suggest the need to provide mental health support for health workers. Keywords: COVID-19, Healthcare workers, Risk perception, Anxiety, Depression, Psychological distress Background The world has grappled with COVID-19 since the first case was diagnosed in Wuhan, China [1]. This has resulted in a global socio-economic crisis and challenged healthcare systems throughout the world. Healthcare workers (HCWs) are at constant risk of many infectious diseases due to the nature of their occupation as evidenced by the previous severe acute respiratory syndrome (SARS) and SARS-coronavirus (SARS-CoV) outbreaks [2–4]. A major concern in the country is the impact of COVID-19 on healthcare workers (HCWs), who are at high risk during novel disease outbreaks. HCWs around the world are at the forefront in screening, quarantining, and managing actual and suspected COVID-19 patients, creating awareness about risks, and advocating for preventive measures [5]. However, not all HCWs are at an equal risk of contracting the COVID-19 infection. In a recent systematic review, frontline HCWs with increased face-to-face interactions, exposure to COVID-19 positive patients, and those working in health facilities designated as treatment centers were shown to have higher infection rates compared to non-front line HCWs [6]. Increased anxiety and depression among frontline healthcare professionals is also a common feature in epidemics [7, 8]. Experience from severe acute respiratory syndrome (SARS) and H1N1 outbreaks highlights how large-scale epidemics and pandemics have a severe psychological strain on healthcare professionals, especially those working on the frontline [9, 10]. Compared to the general public, HCWs face more personal worries such as greater infection risk to self and others and psychological concerns regarding the well-being of their family members [11]. There are disparities in terms of the psychological impact of COVID-19 on HCWs depending on their level of patient care. A study among healthcare professionals in a tertiary infectious disease hospital for COVID-19 in China also revealed a high incidence of anxiety and stress disorders among frontline medical staff, with a higher incidence of anxiety among nurses than doctors [12]. The utility of online surveys to assess psychological distress caused by COVID-19 has proven to be efficient and effective in recruiting large and diverse samples of literate respondents. Social media platforms have thus aided in scientific data collection when other methods of recruitment are no longer safe, practical, and economically feasible. One such study in Hong Kong was developed through Google Forms, which was emailed to councilors of the 18 districts in the region. Although the authors acknowledge the under-sampling of individuals without internet ac (...truncated)