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   Materials and Me...
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ORIGINAL ARTICLE
Year : 2022  |  Volume : 26  |  Issue : 2  |  Page : 105-109
 

Wounded healers of the pandemic: A qualitative study on mental health and protective factors of physicians who recovered from COVID-19


1 ABT Practitioner, P.G. Certificate Course in Psychological Counselling, Presently Pursuing Masters of Arts – Applied Psychology (Counselling Psychology), Tata Institute of Social Sciences, Mumbai, Maharashtra, India
2 Consultant Counselling Psychologist, Mumbai, Maharashtra, India
3 Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
4 Department of Geriatrics, Christian Medical College, Vellore, Tamil Nadu, India
5 Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India

Date of Submission23-Jan-2021
Date of Decision14-Oct-2021
Date of Acceptance11-Dec-2021
Date of Web Publication4-Jul-2022

Correspondence Address:
Dr. Jayaprakash R Ravan
Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar - 751 024, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoem.ijoem_28_21

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  Abstract 


Backgroud: Physicians are at a high risk of being infected by coronavirus disease (COVID-19). Methodology: Our aim was to understand lived experiences of physicians who recovered from COVID-19 by focusing on mental health and psycho-social protective factors through a qualitative study using a narrative approach. A semi-structured questionnaire was outlined referring to literature and seeking experts' opinions. Telephonic interviews were conducted after fulfilling the inclusion criteria. Interviews were transcribed verbatim, and narratives were written and interpreted. Results: Mental health concerns identified from the narratives of five physicians are fear of infecting others, feeling guilty of transmitting infection, stigma, loneliness, and worry about complications after recovery. Social support, faith in a higher power, sense of purpose, and resilience were their sources of strength. Conclusion: Given the vulnerability and professional commitment to serve people, there is an urgent need to address their mental health needs. Support groups and having interactions with mental health professionals during periods of isolation are some recommendations.


Keywords: COVID-19, mental health, physician health, qualitative study


How to cite this article:
Samyuktha VN, Venkatesh V, Kattula D, Wilson BP, Ravan JR. Wounded healers of the pandemic: A qualitative study on mental health and protective factors of physicians who recovered from COVID-19. Indian J Occup Environ Med 2022;26:105-9

How to cite this URL:
Samyuktha VN, Venkatesh V, Kattula D, Wilson BP, Ravan JR. Wounded healers of the pandemic: A qualitative study on mental health and protective factors of physicians who recovered from COVID-19. Indian J Occup Environ Med [serial online] 2022 [cited 2022 Aug 14];26:105-9. Available from: https://www.ijoem.com/text.asp?2022/26/2/105/349856





  Introduction Top


The World Health Organization statistics show that as of January 22, 2021, there are approximately 96,012,792 confirmed cases, including 2,075,870 deaths globally, and 10,625,428 confirmed cases and 153,032 deaths in India.[1] in India, 734 doctors died in 2020 because of COVID-19.[2]

Physicians treating COVID-19 patients are at a high risk of being infected[3] even with adequate personal protective equipment (PPE).[4] They are also at a high risk of mental health issues[5],[6] because of factors such as workload, fear of contracting, and spreading infection.[7],[8],[9]

Liu et al.[10] (2020) looked at lived experiences of HCPs who worked with COVID-19 patients in China. The qualitative study reported the challenges experienced by HCPs in terms of working in a new context, fear of getting infected, and passing on the infection. The study also found resilience and dedication to work as a professional commitment among these professionals.

Although there is data available on mental health issues faced by frontline HCPs, lived experiences of physicians, especially those infected with COVID-19 and recovered, are not much highlighted. There are YouTube videos/blogs/information in newspapers which have described the experiences of doctors who recovered from COVID-19,[11] but academic literature is inadequate. Thus, this paper aims to understand the mental status of physicians who tested positive for COVID-19 and their psycho-social protective factors, through their narratives following their recovery.


  Materials and Methods Top


Approval was obtained from the institute's ethics committee for a larger study “Assessment of psychological health of patients diagnosed with COVID-19” in May 2020. The current study focused on patients who were physicians involved in patient care. The qualitative study with a narrative approach focused on the experiences of individuals through their stories. This approach allows the researchers to present the context and stories of the individuals in relation to their setting, which shapes the participant's narrative identity. The sampling method was non-random, purposive sampling, with the aim of recruiting physicians who had been working with patients and had tested positive for COVID-19. The participants were identified and selected based on the information richness of the cases. We recruited five participants till data saturation was achieved. The exclusion criterion was physicians who tested positive but had not been working with patients. Bracketing for the study was conducted by asking two physicians in the COVID-19 facility to examine the research questions to evaluate if the approach toward the phenomenon under study was objective. Interview as a method was chosen to provide an opportunity for the participant to narrate his or her experience. It allowed the researcher to get the story behind participants' experiences and pursue in-depth exploration where necessary. An interview guide outlined by referring to relevant literature and by seeking expert's opinions was used to collect data. When the participants filled the electronic consent form, they were assigned numbers (P1, P2, and so) to maintain anonymity, and a telephonic interview was scheduled from mid-June to mid-August 2020 for 45 min–1 h in which the discussion was aimed to understand their mental status throughout the experience with being COVID-19 positive and working with patients. The interviews were recorded and transcribed verbatim.

Data analysis in a qualitative study is not a linear process. The transcribed interviews were read multiple times to understand the essence of the participants' experiences. Transcripts were then written as meaningful narratives to understand the personal stories of the physicians with the context of their family and work. The participants were asked to review the narrative to cross-check whether it represents what they shared. These narratives were analyzed for specific themes related to mental health and psycho-social factors. This approach for analysis was developed based on conceptualization given by Bogdan and Bilden (1992).[12] Narratives are provided to highlight the richness of data and their meaningfulness in the discussion. The background and research experience of two authors (psychologists) shaped the conclusions and suggestions provided.

Narrative 1

A 31-year-old married male oncologist with 2 years of experience, presently working in a COVID-19 facility, got tested after he developed symptoms of COVID-19 and was admitted after being positive. He was not sure about how he acquired the infection as he used PPE and traveled minimally. He was scared about the course of the disease and the well-being of his very young daughter, his wife, and the patients he treated. He felt guilty thinking that he was spreading the infection till they were all found to be negative.

As symptoms subsided, he was kept under observation for 7 days. He knew people who were admitted with him, so he felt relaxed after an initial period of anxiety. He was later quarantined for 14 days, which he described as a tiring experience. He felt secluded and spent most of his time sleeping or reading. At the hospital, they had a priest who prayed for everyone, including HCPs. He did not meet anyone during his stay in quarantine. The only mode of communication was over the phone. This made him feel mentally weak. His wife being a HCP understood the course of the disease and kept him motivated.

He used the metaphor of “getting released from jail” when he came back from quarantine, which indicated the level of psychological distress due to isolation. He also mentioned that he had time for himself, eating and sleeping well unlike in his usual life where he would not get sufficient time to have breakfast and to rest adequately due to work pressure.

He also said that being a doctor was an added advantage as he was not alarmed at every symptom. He said that society should be more careful, but clarified that he did not mean that people should be locked inside their homes as that will affect livelihood. He felt everybody should be careful and take necessary safety measures. In the case of testing positive, he said that it is better to act rather than get scared. He was worried about the schedule on rejoining his duty more than his own health.

The experience of getting infected helped him understand the nature of the disease firsthand and thus, he has been actively talking to people to deal with their fears about the disease. He realized his strength was in having people with him, who motivated him through the recovery process.

Narrative 2

A 31-year-old married female dentist with 5 years of experience, presently working in a COVID-19 facility during her second trimester of pregnancy, broke into tears on hearing that she was positive for COVID-19. However, her faith in a higher power allowed her to comfort herself and get admitted in a hospital. She got her family and all the patients she had come in contact with tested and was relieved when they all tested negative.

Her symptoms during the hospital stay included itchy throat, fever, cough, and body pain. Her mood improved when the fever subsided. However, she continued to have cough, which prevented her from talking. She was also worried about taking antibiotics and other medication (painkillers) as she was pregnant. Being in the second trimester of pregnancy, she was concerned about the growing fetus. She described her state as “I freaked out!” when she could not feel the fetal movements for a short period. The doctors monitored the movement and assured her that the fetus was healthy.

During her stay in the hospital, she reported that the staff were very encouraging. She stayed in isolation at home after discharge as she was constantly worried about passing the infection to others. Being a doctor, she considered it was important to be mindful of the safety of others.

She reported that she was afraid of creating fear in the neighborhood, “but to my surprise, though people were afraid and stayed inside their homes and did not venture out for a week, they called me to check on my health status.”

She also said that her family and faith in a higher power encouraged her and helped in coping with stress. She was also part of a WhatsApp support group for doctors who had recovered and also a support group of recovered people helping current patients by providing food and support. After recovery, she decided to take a break from active work as she was concerned about the health of her unborn child.

Narrative 3

A 28-years-old unmarried female dentist with 2 years of experience presently working in a COVID-19 facility turned out to be positive for COVID-19 after she presented with only a persistent headache. She had always been diligent in taking precautions. She probably acquired the infection in public transport which she used to commute to the hospital.

She was admitted in the hospital for 5 days followed by 14 days of isolation. During the hospital stay, she felt better as she had a roommate to talk with. She described loneliness in the isolation center as “mental torture.” When she developed other symptoms toward the end of her isolation period, she felt scared and feared worsening of her symptoms because of which she had sleep disturbances. Her friends were supportive and would call regularly. However, she felt lonely as these interactions lasted only for about an hour a day.

She also shared that a neighborhood shopkeeper enquired about her COVID status with a sense of fear. After her recovery, she felt fearless and grateful to the higher power for having her go through the experience. Her faith in a higher power helped her face the difficulties of isolation. She also felt that there was a stigma attached to being COVID positive, which she hoped would decrease with greater awareness.

She believed that making the choice to serve as a doctor meant that she has to serve even in the most difficult times. Going through the experience made her understand the perspective of patients and helped her be in a better position to give them strength and support.

She emphasized that support groups and having a strong social network were a great source of mental strength for her. She added that having mental health support was imperative as patients can feel frustrated. She felt confident that she could now take better care of her patients. She closed the interview saying “I'm okay. I'm happy. I'm healthy. I'm blessed.”

Narrative 4

A 42-year-old married male emergency medicine and trauma care specialist with 12 years of experience, presently working in the intensive care unit of a COVID-19 facility and the sole breadwinner for a family, was tested positive as he showed symptoms of high-grade fever and cough. His wife also tested positive, while the other three family members tested negative. He became anxious and worried about his children's future and the economic status of the family.

After admission, his condition worsened in the initial days as he developed pneumonia and he panicked that the disease would kill him. He developed nightmares as his lung condition worsened. “The worst nightmare is as if I'm going into ventilator, as if I'm having a sudden death. I was wondering what will happen to my family?” He also had sleep disturbances. He was puzzled about how he contracted the infection as he wore PPF at the workplace. When he could see an improvement in his condition, he felt a strong sense of motivation to fight the disease as the onus of leading his family was on him. He felt that his training as an emergency medicine and trauma care specialist helped him face the disease and not lose hope in treatment when his symptoms worsened, and thus alleviating his distress.

At the time of the interview, he was home-quarantined. He was worried about reinfection once he goes back to duty. This, however, did not deter him from choosing to continue working with COVID-19 facilities as he viewed that as his personal commitment as a doctor.

He believed that there was a lot of stigma associated with COVID. He shared that he had not informed his neighbors about his status because he was afraid that they would discriminate against his family. He shared that his family believed in a higher power and were praying while he relied on medicines and the effectiveness of scientific practices.

He suggested that people should follow measures suggested by the government. He shared that when he goes back to duty, he would opt for staying in a government facility, quarantining himself for a week, before he comes back home, as he intended to keep his family safe.

Narrative 5

A 29-year-old unmarried female ophthalmologist with 3 years of experience, presently working in a COVID-19 facility, was asymptomatic but tested positive for COVID-19 on screening. However, 3 days later, she became symptomatic. She lived with her parents and sister. Her sister also tested positive. She was upset that through her, her sister was affected, and was worried about her aged parents.

She stayed at the hospital for 14 days and then was home-quarantined. During treatment, she reported feeling apprehensive and scared. She felt comfortable when she was asymptomatic; however, as she developed breathlessness, she began to worry. She reported that at one point during the treatment process, she wondered which trajectory would she take- “whether I will get discharged or whether I will succumb to the disease.” She was so stressed that she could not eat or sleep well.

Her family and friends stayed in touch through video calls, which kept her spirits up. Believing in a higher power and having her sister with her during her hospital stay reduced her stress. She had believed that COVID-19 affected the elderly and those with comorbid conditions. However, when she experienced breathlessness, she realized that it could affect anybody, irrespective of age.

Although she was not explicitly discriminated against, she sensed certain fear with which the neighbors viewed her. Despite the distress, she saw the experience as a learning experience to take more precautions and view the disease more seriously. She described her recovery experience as scary.

Having been on both sides, treating patients and also being a patient, she realized that “one needs reassurance that they will be okay” when they are at the hospital. She said that after going back to duty post-recovery, she has been able to understand the needs of patients and fulfill them in whatever capacity. As there are no MHPs who visit patients, doctors themselves play role in maintaining the mental health of patients in COVID-19 wards. She said that she was glad that she recovered from the disease and has gained a better understanding.


  Discussion Top


The narratives of the participants are from the time-bound experience, that is, from the time they were infected to post-recovery, within a specific context of being a doctor. The experiences of these physicians show that even in helpless situations, they felt empowered. All physicians felt that it was their responsibility to treat patients despite knowing that they are at high risk of infection. They said that the job of a doctor is not just enjoying the privilege of occupational status but also facing the risks associated with it.

Fear of infecting one's family and feeling guilty about it, facing stigma from colleagues and neighbors, fear of death, loneliness during quarantine, feelings of distress, and worry are a range of mental health issues that emerged from the interviews. What also emerged is that the participants did not receive systemic mental health support. There seems to be an underlying assumption that those working as HCPs would be able to care for their mental health themselves.[13]

When symptoms worsened, participants reported feeling anxious, sleep disturbances, and nightmares of dying and requiring life support, which caused fear. Spoorthy, Pratapa, and Mahant (2020) show that these are some of the distressing symptoms that HCPs experience while working with COVID-19 patients.[5]

One major stress factor was the safety of one's family in cases where they lived with family, which ranged from worrying about an unborn child, fearing that a young child would be unable to express the symptoms, and infecting elderly parents with comorbid conditions. Additionally, when participants were the sole breadwinner, worries regarding the future economic status of the family was also seen.

These doctors also perceived stigma from the community they lived in. While one described the personal experience of being viewed with stigma, another talked about the fear of being ostracized by the community, which led them to maintain silence regarding the diagnosis. Reports from around the world show the stigma that communities are showing toward HCPs due to their fear of getting infected.[14],[15]

The nature of the disease was better understood as the doctors experienced the disease themselves. While two narratives indicated the shift of perspective from fear to viewing it as a manageable disease, another two showed that experience had created certain apprehension and worry about going back to duty, with the worry of compromised immunity and reinfection. Fear about post-recovery was seen in participants whose symptoms were severe. This may indicate some relation to the existential fear of death, which must be explored further. Two physicians reported that they perceived COVID-19 as a disease that affected the elderly and those with comorbid conditions and therefore did not expect to contract the infection. This seems to highlight a gap in knowledge about the disease.

Social support, sense of purpose, and resilience were the protective factors identified. Social support played a major role in the recovery process. Caring attention from hospital staff, video calls, WhatsApp groups, and reading testimonies gave strength to these HCPs when in isolation. The role of social support has been emphasized by Zhang and Ma (2020) and Walton, Murray, and Christian (2020) for maintaining mental health during periods of isolation.[16],[17]

Faith in a higher power, sense of purpose, personal commitment to serve as a caring and supportive parent, and professional commitment were viewed as strengths that helped them in the recovery process. White (2020) showed that a sense of purpose serves as an internal strength at the time of adversity.[18]

The underlying purpose was resilience too, which may be associated with professional commitment. The narrative that adversities are a part of life and being able to bounce back shows the role of resilience in facing COVID-19. As seen in a qualitative study in China (Liu et al.,[10] 2020), physicians took it upon themselves to provide psychological support to patients. In this present study, participants drew from their personal experience to motivate patients and help them in recovery process. They were also able to be more empathically attuned to their patients' needs and aimed at fulfilling them.

They also mentioned about the added advantage of being a physician when infected, which helped them not be alarmed at unnecessary symptoms, seek help when needed, and understand their health status, which reduced their stress to an extent. They also said that everyone should take care of themselves, acknowledge the seriousness of the disease, get tested when they have symptoms, and health education about the disease can help in reducing stigma.

Although participants in this study dealt with their psychological worries with the help of their personal, social support, they emphasized that providing professional counseling services during the isolation period can help.

Limitation

As the interview was through the telephone, non-verbal clues could not be recorded, which serve as an important component in qualitative studies. However, it was chosen due to the busy schedules of doctors and COVID-19 restrictions. We would be cautious in saying lived experience of these five participants has captured the canvas of mental health of physicians who recovered from COVID-19 in a diverse country like India. This study focused only on physicians. We understand that nurses, technicians, and administrative staff also form the frontline in caring for COVID-19 patients. Future studies are required to understand the experiences of different HCPs, which can provide insights for developing holistic mental health management strategies.


  Conclusion Top


This study throws light on the lived experience of doctors with COVID-19. It shows that being wounded in the process of treatment does not deter them from working. However, providing routine mental health support and systematic interventions such as support groups and personal counseling during isolation can enhance the mental health of HCPs.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

PPE Personal Protective Equipment.

HCP Health Care Professional.

MHP Mental Health Professional.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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