Doctors’ Mental Health in the Midst of COVID-19 Pandemic: The Roles of Work Demands and Recovery Experiences

Abstract

The COVID-19 pandemic potentially increases doctors’ work demands and limits their recovery opportunity; this consequently puts them at a high risk of adverse mental health impacts. This study aims to estimate the level of doctors’ fatigue, recovery, depression, anxiety, and stress, and exploring their association with work demands and recovery experiences. This was a cross-sectional study among all medical doctors working at all government health facilities in Selangor, Malaysia. Data were collected in May 2020 immediately following the COVID-19 contagion peak in Malaysia by using self-reported questionnaires through an online medium. The total participants were 1050 doctors. The majority of participants were non-resident non-specialist medical officers (55.7%) and work in the hospital setting (76.3%). The highest magnitude of work demands was mental demand (M = 7.54, SD = 1.998) while the lowest magnitude of recovery experiences was detachment (M = 9.22, SD = 5.043). Participants reported a higher acute fatigue level (M = 63.33, SD = 19.025) than chronic fatigue (M = 49.37, SD = 24.473) and intershift recovery (M = 49.97, SD = 19.480). The majority of them had no depression (69.0%), no anxiety (70.3%), and no stress (76.5%). Higher work demands and lower recovery experiences were generally associated with adverse mental health. For instance, emotional demands were positively associated with acute fatigue (adj. b = 2.73), chronic fatigue (adj. b = 3.64), depression (adj. b = 0.57), anxiety (adj. b = 0.47), and stress (adj. b = 0.64), while relaxation experiences were negatively associated with acute fatigue (adj. b = −0.53), chronic fatigue (adj. b = −0.53), depression (adj. b = −0.14), anxiety (adj. b = −0.11), and stress (adj. b = −0.15). However, higher detachment experience was associated with multiple mental health parameters in the opposite of the expected direction such as higher level of chronic fatigue (adj. b = 0.74), depression (adj. b = 0.15), anxiety (adj. b = 0.11), and stress (adj. b = 0.11), and lower level of intershift recovery (adj. b = −0.21). In conclusion, work demands generally worsen, while recovery experiences protect mental health during the COVID-19 pandemic with the caveat of the role of detachment experiences.

“We All Really Need to just Take a Breath”: Composite Narratives of Hospital Doctors’ Well-Being during the COVID-19 Pandemic

“…Some doctors reported positive emotions: pride in their work, relief and hope as the worst-case scenarios of overwhelming COVID-19 cases did not come to pass, and inspiration when surrounded by their dedicated peers and colleagues. Negative emotions also came across strongly in interviews—fear, guilt, sadness, frustration—similar to those expressed in studies of other frontline staff working in COVID-19 [ 1 , 2 , 3 , 4 , 5 ]. These negative emotions can all build up into emotional exhaustion, which is a major component of burnout [ 31 ], a serious concern for health workers during COVID-19, as the World Health Organisation has recently identified [ 9 ].…”

“…Some work such as administrative tasks and meetings which previously needed to be done physically in the hospital was changed to be undertaken at home during the lockdown, which also allowed doctors to spend more time at home. This enabled respondent doctors to achieve a better work–life balance, and to improve their diets and exercise levels (as Sean, Bridget and Fiona did), similar to findings from a survey of Malaysian doctors [ 3 ]. Evidence suggests that exercise levels have increased across the general population globally during COVID-19 lockdowns [ 50 ], and doctors may be following this general trend.…”

“…Initial reports focused on the importance of safeguarding health workers from the physical threat of COVID-19, and ensuring they had suitable access to PPE to prevent COVID-19 transmission and protect their physical well-being. As the pandemic evolved and the PPE supply chain was strengthened, threats to mental well-being came into focus for health workers; anxieties about safety of self, patients and family, the moral injury of rationing limited care resources, and isolation due to new protocols like social distancing at work and tele-working [ 1 , 2 , 3 , 4 ]. While some doctors worked on COVID-19 acute care, doctors working in non-acute care also suffered anxiety, fear and guilt over changes to their normal patient care practices, as routine medical care was reduced or shut down to focus resources on COVID-19 [ 5 , 6 ].…”

Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review

“…During COVID-19, feelings that there was inadequate PPE supply at their hospital was associated with worse psychological outcomes [ 107 , 143 , 147 , 157 , 163 , 165 , 170 , 178 , 187 , 188 ]. Physicians working more days, with higher patient volumes, or with increased duties than before than pandemic also had an increased prevalence of psychological symptoms [ 96 , 101 , 122 , 128 , 149 , 187 , 192 , 195 , 198 ]. Eighteen studies reported on insomnia [ 32 , 35 , 36 , 54 , 65 , 69 , 88 , 114 , 128 , 145 , 149 , 163 , 175 , 177 , 181 , 188 , 192 , 194 ], which is associated with psychiatric disorders and is a risk factor for depression and anxiety [ 15 , 32 , 54 , 65 , 69 , 199 , 200 ].…”

COVID-19-Related Fear and Anxiety: Spiritual-Religious Coping in Healthcare Workers in Portugal

“…This review also found that fear of uncertainty or becoming infected was one of the biggest challenges healthcare workers had to cope with [ 7 ]. Other factors such as the frequent growth of COVID-19 cases and deaths due to the disease, lack of resources (material and human), unspecific and ineffective treatments, in addition to an increase in work demands are known to contribute to healthcare workers’ exhaustion and mental health deterioration [ 8 , 9 ].…”