Psychological Distress in South African Healthcare Workers Early in the COVID-19 Pandemic: An Analysis of Associations and Mitigating Factors
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Participants, and Setting
2.2. Data Collection
2.3. Variables and Conceptual Model
2.4. Instruments
2.4.1. General Health Questionnaire
2.4.2. Job-Related Tension Index
2.4.3. Perception of Risks Associated with COVID-19
2.4.4. Training-Related Questionnaire
2.4.5. Support
2.4.6. Questionnaire on Knowledge, Attitude, Practices, and Behaviour
2.5. Data Analysis
3. Results
3.1. Sample Characteristics
3.2. Psychological Distress
3.3. Work-Related Stress and Psychological Distress
3.4. Perception of Risks Associated with COVID-19 and Psychological Distress
3.5. Knowledge, Attitude, Practice and Behaviours during the COVID-19 Pandemic and Psychological Distress
3.6. Training, Supporting and Appreciation Sources and Psychological Distress
3.7. Correlation Analysis
3.8. The Risk or Protective Factors of Psychological Distress
3.9. Mediation and Moderation Analyses
4. Discussion
4.1. Strengths
4.2. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total (N = 154) Valid/Total (%) | Final (N = 122) Valid/Total (%) |
---|---|---|
Gender | 134/154 (87.0%) | 106/122 (86.9%) |
Female | 116 (86.6%) | 90 (84.9%) |
Male | 18 (13.4%) | 16 (15.1%) |
Age (years) | 150/154 (97.4%) | 119/122 (97.5%) |
Median (IQR) | 44.00 (34.00, 54.00) | 34.00 (34.00, 44.00) |
Job Title | 151/154 (98.1%) | 120/122 (98.4%) |
Professional/Assistant/Staff nurses | 100 (66.2%) | 81 (67.5%) |
Other professionals | 51 (33.8%) | 39 (32.5%) |
Work Type | 120/154 (77.9%) | 95/122 (77.9%) |
Inpatient | 112 (93.3%) | 89 (93.7%) |
Outpatient only | 8 (6.7%) | 6 (6.3%) |
Work Years | 126/154 (81.8%) | 99/122 (81.1%) |
Median (IQ1, Q3) | 8.00 (2.00, 12.00) | 8.00 (2.00, 12.00) |
Home Language | 142/154 (92.2%) | 113/122 (92.6%) |
1. English | 3 (2.1%) | 3 (2.7%) |
2. Ndebele | 8 (5.6%) | 8 (7.1%) |
3. Northern Sotho | 33 (23.2%) | 28 (24.8%) |
4. Southern Sotho | 6 (4.2%) | 2 (1.8%) |
5. Swati | 3 (2.1%) | 3 (2.7%) |
6. Tsonga | 15 (10.6%) | 13 (11.5%) |
7. Tswana | 47 (33.1%) | 34 (30.1%) |
8. Venda | 12 (8.5%) | 9 (8%) |
9. Xhosa | 4 (2.8%) | 4 (3.5%) |
10. Zulu | 11 (7.7%) | 9 (8%) |
Prior COVID-19 infection | 145/154 (94.2%) | 113/122 (92.6%) |
Yes | 15 (10.3%) | 12 (10.6%) |
No | 130 (89.7%) | 101 (89.4%) |
Received flu shot this season | 148/154 (96.1%) | 116/122 (95.1%) |
Yes | 49 (33.1%) | 40 (34.5%) |
No | 99 (66.9%) | 76 (65.5%) |
Any MH/stress management workshops prior to COVID-19 | 140/154 (90.9%) | 109/122 (89.3%) |
Yes | 53 (37.9%) | 43 (39.4%) |
If yes, Attended any above workshops | ||
Yes | 36 (69.2%) | 29 (69%) |
No | 16 (30.8%) | 13 (31%) |
No | 87 (62.1%) | 66 (60.6%) |
Item | N b | Mean (SD) a | % Worse c |
---|---|---|---|
ANXIETY/DEPRESSION * | 2.31 | ||
5. Have you felt constantly under strain? | 152 | 2.57 (1.10) | 50.0 |
9. Have you been feeling unhappy or depressed? | 145 | 2.46 (1.18) | 49.0 |
2. Have your worries made you lose a lot of sleep? | 146 | 2.13 (0.98) | 32.1 |
6. Have you had the feeling that you could not overcome your difficulties? | 150 | 2.06 (0.96) | 30.6 |
SOCIAL DYSFUNCTION * | 2.16 | ||
7. Have you been able to enjoy your normal day-to-day activities? | 147 | 2.41 (1.00) | 42.2 |
12. Have you been feeling reasonably happy all things considered? | 142 | 2.25 (1.00) | 33.1 |
1. Have you been able to concentrate well on what you were doing? | 151 | 2.14 (0.87) | 28.5 |
8. Have you been able to face up to your problems? | 148 | 2.11 (0.89) | 29.0 |
4. Have you felt capable of making decisions about things? | 151 | 2.09 (0.98) | 27.2 |
3. Have you felt that you are playing a useful part in things? | 150 | 1.91 (0.93) | 23.3 |
SELF-CONFIDENCE * | 1.89 | ||
11. Have you been thinking of yourself as a worthless person? | 147 | 1.90 (1.13) | 29.3 |
10. Have you been losing confidence in yourself? | 148 | 1.89 (1.10) | 27.0 |
Individual Scores (4-point scale)a | N b | Mean (SE) | |
Average scale (all 12 questions answered) | 122 | 2.11 (0.06) | |
Average scale (at least 10 questions answered) | 147 | 2.16 (0.05) | |
Average scale (at least 6 questions answered) | 152 | 2.17 (0.05) | |
Individual Scores (2-point scale with a total score of 12) d | N b | Mean (SD) d | |
Average scale (all 12 questions answered) | 122 | 3.72 (3.23) | |
Presence of psychological distress (individual 2pt score cut point ≥ 3) | Yes/No | 57.4%/42.6% |
Items | Psychological Distress a | Effect Size | ||
---|---|---|---|---|
Yes | No | p | g | |
4. Feeling that you have too heavy a workload, one that you cannot possibly finish during an ordinary working day | 3.34 (1.28) | 2.71 (1.39) | 0.010 * | 0.476 |
13. Thinking that amount of work that you have to do may interfere with how well it gets done | 3.09 (1.27) | 2.43 (1.10) | 0.004 * | 0.545 |
5. Thinking that you will not be able to satisfy the conflicting demands of the various people over you | 3.04 (1.17) | 2.27 (1.06) | <0.001 * | 0.678 |
1. You have too little authority to carry out the responsibilities assigned to you | 2.99 (1.26) | 2.37 (1.09) | 0.007 * | 0.514 |
9. Having to decide things that affect the lives of individuals, people that you know | 2.94 (1.17) | 2.39 (1.28) | 0.015 * | 0.450 |
15. Feeling that your job tends to interfere with your family life | 2.91 (1.47) | 2.20 (1.31) | 0.006 * | 0.507 |
3. Not knowing what opportunities for advancement or promotion exist for you | 2.86 (1.51) | 2.39 (1.38) | 0.091 | |
14. Feeling that you have to do things on the job that go against your better judgement | 2.80 (1.26) | 2.29 (1.13) | 0.022 * | 0.422 |
7. Not knowing what your immediate supervisor thinks of you and how he or she evaluates your performance | 2.68 (1.14) | 2.45 (1.27) | 0.311 | |
11. Feeling unable to influence your immediate supervisor’s decisions that affect you | 2.62 (1.23) | 2.26 (1.31) | 0.132 | |
10. Feeling that you may not be liked or accepted by the people that you work with | 2.58 (1.13) | 2.08 (1.12) | 0.016 * | 0.444 |
12. Not knowing what the people that you work with expect of you | 2.44 (1.11) | 2.35 (1.14) | 0.639 | |
8. Not being able to get the necessary information to carry out your job | 2.35 (1.21) | 2.10 (1.20) | 0.280 | |
2. Being unclear on just what the scope and responsibilities of your job are doing | 2.18 (1.24) | 2.15 (1.24) | 0.879 | |
6. Feeling that you are not fully qualified to handle your job | 2.00 (1.23) | 1.46 (0.94) | 0.007 * | 0.480 |
Average total score of 15 items (Mean, SD = 37.35, 12.37) | 40.39 (12.08) | 33.45 (11.77) | 0.006 * | 0.576 |
Average score of 15 items b | 2.73 (0.76) | 2.25 (0.78) | 0.001 * | 0.610 |
Psychological Distress a | p | Effect Size | ||
---|---|---|---|---|
Yes | No | g | ||
Questions | Mean (SD) | Mean (SD) | ||
3. I am afraid of falling ill with COVID-19 | 4.93 (1.30) | 4.21 (1.52) | 0.007 * | 0.509 |
8. My family is worried they might get COVID-19 through me | 4.87 (1.50) | 4.40 (1.71) | 0.113 | |
4. I feel I have little control over whether I get infected or not | 4.79 (1.35) | 4.02 (1.69) | 0.008 * | 0.507 |
1. I believe that my job is putting me at great risk | 4.54 (1.69) | 4.21 (1.60) | 0.287 | |
2. I feel extra stress at work | 4.45 (1.47) | 3.18 (1.49) | <0.001 * | 0.852 |
7. I am afraid I will pass COVID-19 on to others | 4.43 (1.65) | 3.76 (1.77) | 0.036 * | 0.388 |
9. I feel altruistic working with COVID-19 | 4.33 (1.46) | 3.73 (1.72) | 0.049 * | 0.377 |
5. I feel I may be unlikely to survive if I get COVID-19 | 3.47 (1.84) | 2.92 (1.78) | 0.101 | |
6. I have thought about resigning because of COVID-19 | 2.93 (1.90) | 1.75 (1.13) | <0.001 * | 0.726 |
Average score of 9 items b | 4.32 (1.00) | 3.58 (1.06) | <0.001 * | 0.713 |
Psychological Distress | p | Effect Size | ||
---|---|---|---|---|
Yes | No | g | ||
Items | Mean (SD) | Mean (SD) | ||
Section 1. Concern about workplace hazards (higher scores meaning less risky and more protection in the workplace) | ||||
1. How hazardous do you feel your workplace is in general? | 1.37 (0.64) | 1.76 (0.77) | 0.003 * | −0.556 |
(Risky to No risk, score from 1 to 4) | ||||
2. How hazardous do you feel your workplace is since the COVID-19 pandemic began? | 1.22 (0.54) | 1.48 (0.74) | 0.038 * | −0.409 |
(Risky to No risk, score from 1 to 4) | ||||
3. Has your behaviour related to infection control changed since COVID-19 pandemic? | (%) | (%) | ||
Yes (following the infection control protocol) | 29.90 | 18.80 | 0.176 | |
No (Always maintained a high level of infection control/not exposed or at risk) | 70.10 | 81.30 | ||
4. From your perspective, is the supply of PPE available to you? | 1.57 (0.70) | 1.65 (0.56) | 0.496 | |
(insufficient/adequate/sufficient, score from 1 to 3) | ||||
Section 2. Compliance with protective practices-COVID-19 (from ‘Never’ to ‘Always’, score 1–5) | ||||
1. I use eye and face protection (other than prescription glasses) | 3.41 (1.38) | 3.80 (1.57) | 0.164 | |
2. I use a surgical mask when dealing with patients when an N95 is not available | 4.31 (1.15) | 4.10 (1.49) | 0.406 | |
3. I wear an N95 | 3.22 (1.56) | 4.06 (1.49) | 0.004 * | −0.545 |
4. I reuse my disposable masks | 2.61 (1.66) | 2.23 (1.66) | 0.234 | |
5. I wear a gown or apron | 3.61 (1.52) | 4.27 (1.19) | 0.011 * | −0.471 |
6. I wear gloves | 3.97 (1.37) | 4.40 (1.20) | 0.086 | |
7. Cleaning supplies are available | 3.80 (1.29) | 4.38 (1.12) | 0.015 * | −0.464 |
Average score of 7 items a | 3.55 (0.84) | 3.90 (0.75) | 0.020 * | −0.438 |
Section 3. Compliance with protective practices-non-COVID-19 (from ‘Never’ to ‘Always’, score 1 to 5) | ||||
1. I use a surgical mask | 4.29 (1.26) | 4.85 (0.55) | 0.001 * | −0.539 |
2. I wear gloves | 3.53 (1.45) | 4.14 (1.50) | 0.028 * | −0.414 |
3. I wear a gown/apron | 3.66 (1.37) | 4.06 (1.51) | 0.143 | |
4. I send them for testing if they report one symptom | 3.83 (1.40) | 4.08 (1.30) | 0.318 | |
5. I send them for testing if they report more than one symptom | 4.29 (1.18) | 4.39 (1.20) | 0.660 | |
Average score of 5 items a | 3.92 (0.88) | 4.31 (1.00) | 0.029 * | −0.412 |
Section 4. Workplace-participative, committed and trusting relationship when taking care of COVID-19 patients (from ‘Never’ to ‘Always’, score 1–5) | ||||
1. I make suggestions for correcting health and safety problems | 3.35 (1.43) | 3.88 (1.30) | 0.045 * | −0.378 |
2. I get clear supervision regarding safe work practices | 3.32 (1.37) | 4.33 (1.00) | <0.001 * | −0.813 |
3. I am encouraged to report injuries and illness at work | 3.93 (1.25) | 4.63 (0.86) | <0.001 * | −0.633 |
4. I trust my manager to make my workplace safe | 3.70 (1.31) | 4.55 (0.94) | <0.001 * | −0.726 |
5. I trust my health and safety committee to make my workplace safe | 3.12 (1.43) | 4.00 (1.19) | <0.001 * | −0.653 |
Average score of 5 items a | 3.50 (1.03) | 4.29 (0.86) | <0.001 * | −0.815 |
Section 5. Perceptions of barriers to infection control practices (from ‘Never’ to ‘Always’, score 1–5) | ||||
1. Not enough time/too much work | 3.74 (1.21) | 2.90 (1.25) | <0.001 * | 0.686 |
2. Poor availability of proper equipment | 3.71 (1.26) | 3.33 (1.45) | 0.129 | |
3. Lack of proper space | 3.61 (1.26) | 2.78 (1.42) | 0.001 * | 0.623 |
4. Do not feel the risk that requires it | 3.14 (1.32) | 2.40 (1.28) | 0.003 * | 0.567 |
5. Peer pressure | 2.83 (1.51) | 1.64 (1.06) | <0.001 * | 0.888 |
6. Not trained well enough | 3.13 (1.49) | 2.42 (1.33) | 0.009 * | 0.502 |
7. Proper supervision not provided | 2.91 (1.34) | 2.25 (1.28) | 0.010 * | 0.497 |
8. Not supported by my manager | 2.67 (1.34) | 2.00 (1.23) | 0.007 * | 0.512 |
Average score of 8 items a | 3.22 (0.84) | 2.46 (0.94) | <0.001 * | 0.858 |
Psychological Distress (Total Score ≥ 3) | ||
---|---|---|
Variables | Full Model | Final Model |
OR (95% CI) | Adjusted OR (95%CI) | |
Training | ||
COVID-19 infection control | 0.37 (0.18, 0.74) ** | |
Emergency procedures | 0.44 (0.27, 0.72) ** | 0.41 (0.21, 0.81) * |
Perceived risks of COVID-19 | 1.99 (1.36, 2.93) ** | 2.35 (1.33, 4.17) ** |
Job-Related Tension Index | 2.24 (1.35, 3.72) ** | |
Social support | ||
Immediate supervisor/boss | 0.56 (0.37, 0.86) ** | |
Concern about workplace hazards | ||
Feel workplace is hazardous in general | 0.46 (0.27, 0.79) ** | |
Feel workplace is hazardous since the pandemic | 0.53 (0.29, 0.95) * | |
Compliance with protective practices (COVID-19) | 0.57 (0.35, 0.92) * | |
Compliance with protective practices (non-COVID-19) | 0.63 (0.41, 0.96) * | |
Workplace relationships | 0.40 (0.25, 0.64) ** | 0.52 (0.27, 0.97) * |
Perceptions of barriers to infection control practices | 2.67 (1.66, 4.29) ** | 2.16 (1.17, 3.98) * |
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Lee, H.-L.; Wilson, K.S.; Bernstein, C.; Naicker, N.; Yassi, A.; Spiegel, J.M. Psychological Distress in South African Healthcare Workers Early in the COVID-19 Pandemic: An Analysis of Associations and Mitigating Factors. Int. J. Environ. Res. Public Health 2022, 19, 9722. https://doi.org/10.3390/ijerph19159722
Lee H-L, Wilson KS, Bernstein C, Naicker N, Yassi A, Spiegel JM. Psychological Distress in South African Healthcare Workers Early in the COVID-19 Pandemic: An Analysis of Associations and Mitigating Factors. International Journal of Environmental Research and Public Health. 2022; 19(15):9722. https://doi.org/10.3390/ijerph19159722
Chicago/Turabian StyleLee, Hsin-Ling, Kerry S. Wilson, Colleen Bernstein, Nisha Naicker, Annalee Yassi, and Jerry M. Spiegel. 2022. "Psychological Distress in South African Healthcare Workers Early in the COVID-19 Pandemic: An Analysis of Associations and Mitigating Factors" International Journal of Environmental Research and Public Health 19, no. 15: 9722. https://doi.org/10.3390/ijerph19159722