Anxiety, health-related quality of life, and symptoms of burnout in frontline physicians during the COVID-19 pandemic

Chalhub, Ricardo Ávila; Menezes, Marta Silva; Aguiar, Carolina Villa Nova; Santos-Lins, Larissa Souza; Martins Netto, Eduardo; Brites, Carlos; Lins-Kusterer, Liliane

doi:10.1016/j.bjid.2021.101618

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Brazilian Journal of Infectious Diseases

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Original Article • Braz. j. infect. dis 25 (05) • 2021 • https://doi.org/10.1016/j.bjid.2021.101618 copy

Anxiety, health-related quality of life, and symptoms of burnout in frontline physicians during the COVID-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

COVID-19 pandemic caused increased workload and stress for health professionals involved in the care of such patients. We aimed to describe the health-related quality of life, and burnout in frontline physicians diagnosed with anxiety during the COVID-19 pandemic.

Methods:

This was a cross-sectional study conducted during the first-wave phase of COVID19, from September to October 2020. Questionnaires were sent electronically to 450 physicians from State of Bahia, assessing symptoms of anxiety, health-related quality of life (HRQOL) and burnout syndrome. For the categorical variables, the Pearson’s chi-square test was used and difference between means was compare using the Mann-Whitney test. was Groups with and without anxiety symptoms were compared using prevalence ratios (PR). Pearson’s correlation measured the correlation between WHOQOL-BREF and MBI (Maslach Burnout Inventory) domains. The Fisher r-to-z transformation was used to assess the significance of the difference between two correlation coefficients. The significance level was <0.05.

Results:

Out of the 450 physicians, 223 (49,6%) completely answered the questionnaire and 38 (17%) showed symptoms of anxiety. Physicians with anxiety had higher scores in emotional exhaustion (EE) (38.31 ± 8.59 vs 25.31±0.87; p = 0.0001) and depersonalization (DP) (9.0 ± 5.6 vs 5.9 ± 5.3; p = 0.001) domains, and lower scores in personal accomplishment (PA) (32.1 ± 8.2 vs 36.3 ± 7.6; p = 0.004), than those without anxiety. All correlations between WHOQOL-BREF domains and MBI in physicians without anxiety were significant (p = 0.01). Conclusion: Physicians with anxiety showed more emotional exhaustion, less personal accomplishment, and lower quality of life. All domains of WHOQOL BREF were correlated with all MBI domains among physicians without anxiety. Differences in correlation according to anxiety were remarkable in psychological HOQOL BREF domain and emotional exhaustion and depersonalization MBI domains. The effect of anxiety leading to poorer levels of perceived health needs to be further investigated.

Keywords:
COVID-19; Physicians; Health-related quality of life; Anxiety; Professional burnout

Beck anxiety inventory (BAI)	N	%
Minimal anxiety (0-7)	123	55.2
Mild anxiety (8-15)	62	27.8
Moderate anxiety (16-25)^a a The cutoff for clinical symptoms of anxiety is ≥16 12.	30	13.5
Severe anxiety (26-63)	8	3.6
Total	223	100.0

Socio-demographic and occupational characteristics	N = 223	With anxiety N = 38	Without anxiety N = 185	PR	p-value^a a Chi-square test (2-tail).
Sex - N (%)					0.007
Male	120 (53.8)	13 (10.8)	107 (89.2)	1
Female	103 (46.2)	25 (24.3)	78 (75.7)	2.24
Marital Status - N (%)					0.068
In a relationship with someone	118 (52.9)	15 (12.7)	103 (87.3)	1
Single (presently without partner)	105 (47.1)	23 (21.9)	82 (78.1)	1.72
Religion - N (%)					0.211
Non-religious	46 (20.6)	5 (10.9)	41 (89.1)	1
Religious	177 (79.4)	33 (18.6)	144 (81.4)	1.71
Income (in Brazilian Real)^b b 1USD=5.46BR. - N (%)					0.061
<10,000	36 (16.1)	26 (72.2)	10 (27.8)	1
≥10,000	187 (83.9)	159 (85)	28 (15)	1.18
Work experience - N (%)					0.078
>10 years	117 (52.5)	15 (12.9)	102 (87.1)	1
<10 years	106 (47.5)	23 (21.7)	83 (78.3)	1.70

Pandemic COVID-19- related aspects	N = 223	With anxiety N = 38	Without anxiety N = 185	PR	p-value
COVID-19 pandemic demands much more work from you? - N (%)
Never/Very rarely/Rarely	28 (12.6)	3 (10.7)	25 (89.3)	1
Frequently/Very frequently	195 (87.4)	35 (17.9)	160 (82.1)	1.67	0.511^a a Fisher's test (2-tail).
Have accomplished all job tasks? - N (%)
Never/Very rarely/Rarely	6 (2.7)	1 (16.7)	5 (83.3)	1
Frequently/Very frequently	217 (97.3)	37 (17.1)	180 (82.9)	1.02	0.999^a a Fisher's test (2-tail).
Feel safe when using Personal Protective Equipment in your job? - N (%)
Never/Very rarely/Rarely	48 (21.5)	11 (22.9)	37 (77.1)	1.48
Frequently/Very frequently	175 (78.5)	27 (15.4)	148 (84.6)	1	0.222^b b Chi-square test (2-tail).
Have you increased your alcohol ingestion? - N (%)
Never/Very rarely/Rarely	140 (62.8)	18 (12.9)	122 (87.1)	1
Frequently/Very frequently	83 (37.2)	20 (24.1)	63 (75.9)	1.87	0.030^b b Chi-square test (2-tail).
Are you using stimulants because of COVID-19 pandemic? - N (%)
Never/Very rarely/Rarely	204 (91.5)	29 (14.2)	175 (85.8)	1
Frequently/Very frequently	19 (8.5)	9 (47.4)	10 (52.6)	3.33	0.002^a a Fisher's test (2-tail).
Avoid attending patients suspected of COVID-19 - N (%)
Never/Very rarely/Rarely	118 (52.9)	14 (11.9)	104 (88.1)	1
Frequently/Very frequently	105 (47.1)	24 (22.9)	81 (77.1)	1.93	0.029^b b Chi-square test (2-tail).
Psychological support from co-workers - N (%)
Never/Very rarely/Rarely	21 (9.4)	5 (23.8)	16 (76.2)	1.45
Frequently/Very frequently	202(90.6)	33 (16.3)	169 (83.7)	1	0.549^a a Fisher's test (2-tail).
Feel able to manage COVID-19 cases - N (%)
Never/Very rarely/Rarely	17 (7.6)	3 (17.6)	14 (82.4)	1.03
Frequently/Very frequently	206 (92.4)	35 (17.0)	171 (83.0)	1	0.999^a a Fisher's test (2-tail).
Decrease in quality of social relationships - N (%)
Never/Very rarely/Rarely	47 (21.1)	4 (8.5)	43 (91.5)	1
Frequently/Very frequently	176 (78.9)	34 (19.3)	142 (80.7)	2.27	0.080^b b Chi-square test (2-tail).

MBI domains	N = 223 M ± SD	Cronbach's alpha	With anxiety N = 38 M ± SD		Without anxiety N = 185 M ± SD		p-value^a a Student's t-test (with anxiety versus without anxiety).
Emotional exhaustion (EE) -	27.53 ± 11.59	0.88	38.31 ± 8.59	High	25.31 ± 0.87	Moderate	0.0001
Depersonalization (DP)	6.44 ± 5.45	0.69	9.02 ± 5.62	Moderate	5.91 ± 5.27	Moderate	0.001
Personal accomplishment (PA) -	35.62 ± 7.87	0.82	32.13 ± 8.16	High	36.34 ± 7.64	Moderate	0.004

WHOQOL-BREF domains	N = 223 M ± SD	Cronbach's alpha	With anxiety N = 38 M ± SD	Without anxiety N = 185 M ± SD	p-value^a a Mann-Whitney's Test (with anxiety versus without anxiety).
Physical	12.87 ± 1.87	0.79	11.54 ± 1.74	13.15 ± 1.78	0.0001
Psychological	14.03 ± 3.13	0.89	10.87 ± 3.45	14.68 ± 2.63	0.0001
Social Relationships	13.53 ± 3.20	0.65	11.40 ± 3.37	13.96 ± 2.99	0.0001
Environment	14.82 ± 2.23	0.77	13.50 ± 2.12	15.10 ± 2.16	0.0001

	With anxiety N = 38 MBI domains			Without anxiety N = 185 MBI domains
WHOQOL-BREF domains	Emotional exhaustion (EE)	Depersonalization (DP)	Personal accomplishment (PA)	Emotional exhaustion (EE)	Depersonalization (DP)	Personal accomplishment (PA)
Physical	-0.30	-0.15	0.42^⁎⁎	-0.51^⁎⁎	-0.28^⁎⁎	0.36^⁎⁎
Psychological	-0.27^a	-0.11^b	0.53^⁎⁎	-0.56^⁎⁎^a	-0.41^⁎⁎^b	0.51^⁎⁎
Social Relationships	-0.13	-0.05	0.38*	-0.38^⁎⁎	-0.23^⁎⁎	0.30^⁎⁎
Environment	-0.12	-0.32*	0.36*	-0.37^⁎⁎	-0.34^⁎⁎	0.49^⁎⁎

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[1] * Corresponding author at: Faculty of Medicine, Federal University of Bahia, Avenida Reitor Miguel Calmon s/n, CEP 40110-100, Salvador, Bahia, Brazil. E-mail address: lkusterer@gmail.com (L. Lins-Kusterer).