Fear and Anxiety among Health Care Workers amid COVID-19; Role of Social Support and Religious Beliefs, Study Guides, Projects, Research of Research Methods in Psychology

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Contents Introduction ................................................................................................................................... 2 Rationale of the Study .................................................................................................................. 4 Hypothesis ...................................................................................................................................... 4 Method and Materials .................................................................................................................. 5 Research Design ............................................................................................................................ 5 Participants .................................................................................................................................... 5 Research Instruments ................................................................................................................... 5 Depression Anxiety Stress-Scale (DASS) ............................................................................... 5 Perceived Fear Scale (PFS) ..................................................................................................... 5 Multidimensional Scale of Perceived Social Support (MSPSS) ............................................. 5 Religious Belief Scale (RBS) .................................................................................................. 5 Procedure and Data Analysis ....................................................................................................... 5 Results ............................................................................................................................................ 6 Discussion....................................................................................................................................... 8 Conclusion ..................................................................................................................................... 9 Limitations ..................................................................................................................................... 9 Implications ................................................................................................................................. 10 Ethical Consideration ................................................................................................................. 10 References .................................................................................................................................... 11 Appendix ...................................................................................................................................... 16 2 Fear and Anxiety among Health Care Workers amid COVID-19; Role of Social Support and Religious Beliefs The increasing cases of Covid-19 in the country made it necessary to find out psychological health related issues such as fear and anxiety among Health Care Workers (HCWs). Current study aims to study the extent of fear and anxiety among HCWs along with the role of social support and religious beliefs. The sample consisted of 198 Health Care Workers. Results showed a high positive correlation between fear and anxiety [r(196) = .58, p < .01]. Health Care Workers reported high anxiety and fear despite receiving social support. Religious beliefs were positively correlated with fear [r(196) = .27, p < .01] suggesting that HCWs having high fear had strong beliefs that practicing religion would reduce their fear of being infected with COVID-19. Results also indicated that paramedical staff had the highest degree of anxiety (M=10.03, SD=5.44) and fear (M=24.75, SD=7.32) followed by nurses and doctors. These findings will help for future implications of psychological and psychiatric interventions by hospital authorities for the better psychological well-being of HCWs. Introduction The month of November in 2019 brought an unexpected and unprecedented outbreak of a new virus in Wuhan, city of China. This virus was given the name Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Rothan & Byrareddy, 2020). An emergency meeting was held by World Health Organization on January 30, 2020. They declared the global Covid-19 outbreak a public health emergency of international concern. First case of COVID-19 in Pakistan was reported in Karachi on 26th February 2020 and gradually worsening the situation. In the world, it became 16th country with a large number of confirmed Covid-19 cases. Covid-19 is an erratic and very tense time for health care workers with irresistible confirmed and suspected caseloads, challenges towards self-protection, lack of sleep due to overnight shifts, absence of resources i.e., shortage of masks and PPE (personal protection equipment), media coverage at global level, absence of Covid-19 specific medicine, growth of illogical myths and getting inadequate support while maintaining a high level of patient care, diagnosis and treatment. The virus poses serious problems for medical staff. By May 2020, over 90,000 health care workers were infected with COVID-19 globally (WHO, 2020). The current study is conducted to address these issues with an aim to assess mental health issues i.e., anxiety and fear quantitatively, among health care workers dealing with Covid-19 patients by incorporating role of social support and religious beliefs of health care workers. This research will cater the high emotional reactivity of the health care workers amid corona virus and what threats these emotional reactive events impose on themselves and person they are dealing with. (Grupe & Nitschke, 2013). Different researches and studies on past pandemics such as Ebola, H1N1 and SARS reported that medical workers suffered from many psychological issues such as xenophobia, anxiety, stress, depression, PTSD and stigmatization (Prati & Pietrantoni, 2016; Peeri et al., 2020; Lee et al., 2015; Wu et al., 2003). A viral infection having no antidote, and spreading enormously usually creates a situation of panic. When such an unprecedented situation occurs, the healthcare professionals have to take some difficult measures and decisions to treat patients and control the outbreak without creating panic in the public (Nyashanu, 2010). The emotions are deeply linked with the individuals and during such a situation, they usually play a major role. Fear and anxiety are playing a major role during pandemics and are very much interlinked. Fear invokes anxiety and anxiety disturbs our thoughts and functioning. Fear is basically an emotional response towards the situation and an alert which indicates that a danger is present or 5 H2: Social support and Religious beliefs play a mediating role in fear and anxiety of health care workers working on the front line amid Covid-19 H3: Nurses experience more fear and anxiety than doctors. Method and Materials Research Design The correlational research design was used to access the relationship between fear, anxiety, social support and religious beliefs among health care workers (HCW) amid COVID-19. Non- probability snowball sampling technique was used to recruit the participants, and online selection of participants was made by using google survey forms, keeping in view the inclusion and exclusion criteria. Participants The sample consisted of one hundred and ninety-eight (N=198) Health Care Workers (HCW) and it was observed that 89(44.9%) out of 198 were females and 109(55.1%) out of 198 were males. The age ranges from minimum 22 to maximum above 40 years, out of which 103(52%) of 198 participants falls in the category of young adults, 57(28.8%) out of 198 falls in the category of middle adults and 38(19.2%) out of 198 falls in the category of old adults. The sample was approached from twenty different hospitals of Pakistan, and mainly from the hospitals of Punjab. Out of total (N=198) HCWs that participated in this study, 138(69.7%); 31(15.7%) & 29(14.6%) were doctors, nurses, and other paramedical staff respectively. Research Instruments Four variables used in the study were assessed by using well established scales. Depression Anxiety Stress-Scale (DASS) Depression Anxiety Stress-Scale (DASS) was developed by Lovibond and Lovibond. The Depression, Anxiety and Stress Scale-21 Items (DASS-21) is the set of three self-report scales design to measure negative emotional states of depression, anxiety, and stress. Each of the three DASS-21 scales contains 7 items, divided into subscales with similar content. We have selected 6 items from anxiety scale of (DASS-21) to measure anxiety of covid-19. The rating scale ranged from 0-3 with 0 means did not apply to me at all and 3 means applied to me very much. Perceived Fear Scale (PFS) PFS is a self-constructed scale to assess the fear of Covid-19 and consists of 5 items which were developed as a result of reviewing the literature. The 7-point likert scale is used from strongly disagree to strongly agree indicating how much the statement applied to the participants. Multidimensional Scale of Perceived Social Support (MSPSS) Multidimensional Scale of Perceived Social Support by Zimet, et al., (1988) consists of 12 items. The items tended to divide into factor groups relating the source of social support, namely family members, friends, or significant others. But we have just short-listed item no. 3, 4, 6, 8, 11, and 12 and then modified and constructed 5 items to assess social support in our participants. The 5-point liker scale was used that ranged from strongly disagree to strongly agree. Religious Belief Scale (RBS) The items for religious beliefs have been taken from Religious Belief Scale by Chiang, et al., (2017) and modified to fit them with the current study to fulfill the purpose. This scale consisted of 5 items to access the religious beliefs of participants during pandemic Covid-19. The 5-point likert scale is used from strongly disagree to strongly agree indicating how much the statement applied to the participants. Procedure and Data Analysis Questionnaire was created online on google forms and shared with contacts using snowball 6 technique. Participants were approached online on various social media platforms due to lockdown; the questionnaires were given to them and data was collected online from N= 198 participants. Before administration, the participants were briefed about the nature and purpose of the study. Written consent was obtained from all the participants individually. After collecting the responses, the data was exported from google form to excel and then to SPSS. It was then scored and analyzed using SPSS version 21. Results Table 1 Correlation between Fear, Anxiety, Social Support and Religious Beliefs. 1 2 3 4 5 6 7 8 1 Profession - .24** 1.96** .21** .33*** .31*** .13 .10 2 Age - .68*** .65*** .32*** .18* -.02 -.16* 3 Service - .46*** .29*** .18* -.02 -.14* 4 Marital Status - .37*** .21** .06 -.09 5 DASS - .58*** .22** .08 6 PFS - .25*** .27*** 7 MSPSS - .46*** 8 RBS - Note. N=198. DASS= Depression Anxiety Stress Scale; PFS=Perceived Fear Scale; MSPSS= Multidimensional Scale of Perceived Social Support; RBS= Religious Belief Scale *p<.05, **p<.01, ***<.001. According to results drawn from correlational analysis on SPSS version 21, as shown in Table 1, demographics like age were having significant relationship with variables (anxiety, fear, social support and religious beliefs). Age was positively correlated with anxiety. Age and fear were also positively correlated. This shows that anxiety and fear level increased as the age increased. Age and religious beliefs were negatively associated. It means young adults had strong religious beliefs and older adults had weak religious beliefs. Anxiety and fear were also strongly positively associated with each other, showing higher the anxiety, higher would be the level of fear in them and vice versa. Anxiety was also significantly correlated with social support. Fear and social support were also having positive correlation between them. This positive relation shows that higher was the level of anxiety and fear, greater social support participants had received from their family or friends and vice versa. Fear and religious beliefs had also shown a positive correlation, showing that HCWs having high fear had strong beliefs that practicing religion would reduce their fear of being infected and vice versa. Table 4 Multiple linear regression; predicting fear of being infected with COVID Variables R2 β 95% CI LL UL Model .23 Profession .25** 1.10 3.88 Gender -.13 -3.86 .15 Age .05 -1.55 2.39 Years of service .09 -.57 1.83 Shifts of work .07 -.64 2.30 Home town .06 -1.12 3.19 Family system .005 -1.82 1.97 7 Note. N=198. PFS=Perceived Fear Scale; MSPSS= Multidimensional Scale of Perceived Social Support *p<.05, **p<.01, ***<.001. Table 2 shows that a multiple linear regression was run to predict the fear of being infected with COVID-19. We added profession, gender, age, years of services, shifts of work, hometown, family system, marital status, social support and religious beliefs in the model. The model explained 23% variance in fear, where profession was the highest significant predictor for fear of being infected with COVID-19 followed by religious beliefs which also act as significant predictor of fear amid COVID-19. Both were positive predictors of fear of being infected with COVID-19, among healthcare workers indicating that health care workers with higher degree of fear of being infected with COVID-19 were having stronger religious beliefs. Table 3 Multiple linear regression; predicting anxiety of being infected with COVID Variables R2 Β 95% CI LL UL Model .26 Profession .23 .57 2.19 Gender -.03 -1.49 .91 Age .04 -.98 1.34 Years of service .07 -.43 1.01 Shifts of work -.06 -1.31 .46 Home town -.07 .31 -1.97 Family system .04 -.78 1.49 Marital status .22* .22 1.56 MSPSS .17* .03 .35 RBS .04 -.14 .23 Note. N=198. PFS=Perceived Fear Scale; MSPSS= Multidimensional Scale of Perceived Social Support *p<.05 Table 3 shows that a multiple linear regression was also calculated to predict anxiety in health care workers. We added profession, gender, age, years of services, shifts of work, hometown, family system, marital status, social support and religious beliefs in the model. The model explained 23% variance in anxiety, where marital status was the highest significant predictor for causing anxiety in health care workers followed by social beliefs. Both were positive predictors of anxiety among healthcare workers. Results showed that health care workers with high anxiety level were receiving more social support from family, friends or from others. Table 4 ANOVA results showing effect of social support and religious beliefs on anxiety and fear in doctors, nurses and other paramedical staff Measure Doctor Nurse Other (Paramedic Staff) F(2,195) η2 M SD M SD M SD DASS 6.45 3.93 9.42 4.38 10.03 5.44 12.52*** .11 PFS 19.0 6.91 22.84 6.97 24.72 7.32 10.23*** .10 Note. N=198. DASS= Depression Anxiety Stress Scale; PFS=Perceived Fear Scale ***<.001. Marital status .08 -5.40 1.67 MSPSS .12 -.05 .48 RBS .19* .08 .69 10 Implications This research will open more grounds for further study on this topic in future. This research study will help in focusing on the psychological issues of the health care workers in understanding the factors that are contributing to fear and anxiety and helps in resolving them (Amin et al., 2020; Kang et al., 2020). In addition, this research will help in focusing on the training of health care workers and the work protocol in case of any pandemic (Munawar & Choudhry, 2020; Ahorsu et al., 2020). This research will help the authorities to organize educational and informational programs to keep the public up-to-date and avoid misconceptions. It will help them to take necessary steps to stop the spread of virus and to organize centers and workshops for the psychological help (Amin et al., 2020). This study can help provide the directions that are needed to be considered and to overcome the previous shortcomings for effective dealing during any pandemic and to promote the well-being of the health care workers and society. This study also highlights the need of effective social and government support to health care workers during such pandemic conditions. For instance, health care system can make sure the availability of personal protective equipment to all health care workers during any crisis situation. This study enlightens the strength of religious beliefs by establishing that strong religious beliefs can lead to better mental and physical health in medical workers with high level of anxiety and fear. Ethical Consideration Ethical considerations were followed: 1. Prior permission for the use of scales was taken from respective authors. 2. Informed consent was taken from concerned participants and they were briefed about the research. 3. Anonymity of the participants and confidentiality of the data was maintained. 4. Participants were given the right to withdraw at any part of the research. 11 References Amin, F., Durrani, N., Jilani, D, Saeed, R., & Sharif, S. (2020). COVID-19 Pandemic- Knowledge, Perception, Anxiety and Depression Among Frontline Doctors of Pakistan. Research Square. https://doi.org/10.21203/rs.3.rs-27559/v1. Alwani, S.S., et al., (2020). 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Frontiers in Psychiatry, 11, 386. https://doi.org/10.3389/fpsyt.2020.00386 16 Appendix Questionnaire for health care workers, performing their duties as a front liner amid COVID'19. 1. Consent Form I understand that my participation is completely voluntary. All my answers will be used ONLY for research purposes. No personal data will be stored, and my answer will be completely anonymous. Please note that you can leave the survey at any time. By ticking the box, you are agreeing that you are at least 22 years old, a doctor, nurse or any other health care worker and that you voluntarily agree to take part in it. Tick all that apply. I agree to participate in this study_____ Demographic Information 2. Profession Doctor__ Nurse__ Other__ 3. Since how many weeks have you been working as front liners during current situation of COVID'19 pandemic? Less than one week___ 1-2 weeks___ 3-4 weeks___ 5 or more weeks___ 4. Hospital in which you are working during COVID'19 Pandemic (write full name of hospital with city name? _________________________________________________________________ 5. Years of service________________ 6. Duty Hours per day _____________ 7. Shifts of work per day ___________ 8. Area of specialization? ___________ 9. Age 22-30___ 31-39___ 40 and above___ 10. Gender Female____ Male___ Other (Mention If any) __________ 11. Where do you belong? Rural__ Urban__ 12. Family System Joint___ Nuclear___ 13. Marital Status Single___ Engaged___ Married___ Widowed___ Divorced___ Separated___ Items Section I Please read each statement and choose a number 0, 1, 2 or 3 which indicates how much the statement applied to you over the past few weeks by imagining the current pandemic situation of COVID-19. There are no right or wrong answers. Do not spend too much time on any statement. The rating scale is as follows: 0 Did not apply to me at all 1 Applied to me to some degree, or some of the time 2 Applied to me to a considerable degree or a good part of time 3 Applied to me very much or most of the time 1. The fear of being infected with virus makes me agitated and restless most of the time. Did not apply to me at all 0__ 1__ 2__ 3__ Apply to me very much or most of the time 17 2. This apprehension does not let me concentrate on my work Did not apply to me at all 0__ 1__ 2__ 3__ Apply to me very much or most of the time 3. I was aware of dryness of my mouth while dealing with COVID'19 patients. Did not apply to me at all 0__ 1__ 2__ 3__ Apply to me very much or most of the time 4. I experienced breathing difficulty (e.g. excessively rapid breathing, heart races or palpitates or breathlessness in the absence of physical exertion) while working with patients infected with COVID'19. Did not apply to me at all 0__ 1__ 2__ 3__ Apply to me very much or most of the time 5. I experienced trembling (e.g. in the hands) while dealing with patients infected with COVID'19. Did not apply to me at all 0__ 1__ 2__ 3__ Apply to me very much or most of the time 6. I felt I was close to panic while working with patients infected with COVID'19 Did not apply to me at all 0__ 1__ 2__ 3__ Apply to me very much or most of the time Section II Please read each statement and choose any number from 1 to 7 which indicates how much the statement applied to you over the past few weeks by imagining the current pandemic situation of Covid-19. There are no right or wrong answers. Do not spend too much time on any statement. The rating scale is as follows: Don’t worry at all [1] [2] [3] [4] [5] [6] [7] worry a lot 1. I am afraid of being infected by virus (COVID'19). Don’t worry at all 1__ 2__ 3__ 4__ 5__ 6__ 7__ Worry a lot 2. I am afraid of losing my life because of virus (COVID'19). Don’t worry at all 1__ 2__ 3__ 4__ 5__ 6__ 7__ Worry a lot 3. I am worried about my mental health, being disturbed during current situation of COVID'19 pandemic. Don’t worry at all 1__ 2__ 3__ 4__ 5__ 6__ 7__ Worry a lot 4. I am worried about my sleep pattern which is disturbed due to COVID'19.(Sleep disturbance due to increase duty/working hours and due to fear of being infected with virus.) Don’t worry at all 1__ 2__ 3__ 4__ 5__ 6__ 7__ Worry a lot 5. I am worried about life safety, physical and mental health of my loved ones Don’t worry at all 1__ 2__ 3__ 4__ 5__ 6__ 7__ Worry a lot Section III We are interested in how you feel about the following statements by imagining the current pandemic situation of Covid-19. Read each statement carefully. Indicate how you feel about each statement. There are no right or wrong answers. Do not spend too much time on any statement. The rating Scale is as follows: “1” Strongly Disagree “2” Disagree “3” Neutral “4” Agree “5” Strongly Agree 1. I am finding complete moral and emotional support from my family, friends and other people around me during current pandemic situation. Strongly Disagree 1___ 2___ 3___ 4___ 5___ Strongly Agree 2. I can discuss my fears and problems related to COVID'19 with my family and friends. Strongly Disagree 1___ 2___ 3___ 4___ 5___ Strongly Agree