The current study investigated the overall mental health condition and the impact of COVID-19 on the mental health among the nurses of Bangladesh. To our knowledge, our study is the first of its kind during this COVID-19 pandemic that has been carried out among the nurse community to provide the spotlight on this neglected category of health professionals in Bangladesh.
This study revealed that 61.9% of nurses in our sample suffered from some degree of mental distress during the COVID-19 outbreak in Bangladesh; 50.5% was documented to have some degree of depression, 51.8% had some degree of anxiety, and 41.7% had some degree of stress. A similar study conducted in Nepal found high rates of psychological distress (41.9% had symptoms of anxiety, and 37.5% had symptoms of depression) during the COVID-19 outbreak among healthcare workers [17]. Another study conducted among the Chinese healthcare workers also reported symptoms of depression at 50.4%, anxiety at 44.6%, and distress at 71.5% [14]. A multinational study revealed low psychological impact (7.4%), depressive symptoms (10.6%), anxiety symptoms (15.7%), and stress level (5.2%) during this pandemic as compared to our study findings, conducted among the healthcare workers in Singapore and India [22]. This difference might be due to the variations in time of conducting the studies and also variations in demographic profiles of study participants. Health care workers exert a complicated psychological response to an epidemic of infectious diseases. Psychological distress may result from the thoughts of insecurity or lack of control and poor self-esteem, higher infection rate, well-being of the family and friends, workloads, and loneliness due to the quarantine [26, 27]. In addition, predictable stock shortages and a growing flow of reported and real COVID-19 reports lead to the stresses and worries among the healthcare staff [28].
In this study, between both genders, males had lesser depression, anxiety, and stress level and psychological effect during the COVID-19 outbreak as compared to their female counterparts. This finding was similar to the other studies where females suffered greater mental distress and poor mental health outcome during this COVID-19 outbreak [14, 23, 29].
The nurses of the tertiary level healthcare facilities are suffering from higher level of anxiety and stress as revealed in our study. In China, a multicenter study suggested that nurses of secondary hospitals experienced more depression and anxiety [14]. However, in Bangladesh, the nurses of tertiary level healthcare facilities had to deal with a huge number of patients compared to the primary or secondary level healthcare settings which might interact with the mental health during COVID-19 [30].
Our study showed that nurses who had a lower educational degree experienced lower impact from the COVID-19 pandemic psychologically and lower depression, anxiety, and stress scores, suggesting less mental distress than the nurses who had higher education. However, a study in the UK suggests that it was less stressful to work with patients if the nurses have higher education and strategies to manage mental health problems [31]. This contrary finding might be because, in healthcare settings in Bangladesh, less educated nurses had less responsibilities and leadership roles, so less exposure to potentially stressful situations.
Our study outcomes indicate that during the pandemic, the preventive arrangements taken to control the transmission of COVID-19 may have had protective psychological effects. The evidence from 2003 SARS-CoV epidemic study revealed that moderate anxiety had an association with the practice of high level of preventive measures [32]. Our outcome is also following this same trend. The safety measures for the nurses, particularly having complete PPE during working, come with low mental distress. Another significant finding in our study from regression analysis is that the nurses who faced any emotional abuse for being healthcare workers and working in COVID-19 pandemic situations were associated with higher levels of depression, anxiety, stress, and psychological impact. Similar study conducted in Nepal found that healthcare workers who faced stigma during the COVID-19 outbreak were more at risk of developing mental health outcomes [17]. In Bangladesh, health care workers are facing social stigma since the outbreak of COVID-19 [33]. A research from China also found that individuals with a greater propensity to communicate their mental health distress is the product of social stigma [34].
In this study, no significant association has been established between psychological outcomes and the working position of the nurses during COVID-19. This study finding is similar to the results of studies conducted in Nepal and Italy [17, 35]. However, several other studies indicate that nurses who are involved with managing COVID-19 patients directly were at the highest risk of getting the diseases [36, 37], and they experienced more adverse psychological outcomes than their counterparts [14, 38]. As most of the COVID-19 cases had mild symptoms, working position might not have contributed to a significant difference in mental health outcomes. The similarity between the frontline and second-line nurses regarding psychological outcomes in our study may be due to that second-line nurses also remain suspicious and have fear of getting affected as they deal with the patients whom they do not know are infected or not. Further research might be required in this area to confirm this finding as the association might vary over the course of the epidemic in the country.
Therefore, to improve the mental health and well-being of the nurses, multi-disciplinary interventions are necessary by addressing psychological outcomes. Dedicated counseling should be arranged to support the psychological well-being of nurses to help improve their morale. The government and the health authorities should ensure that there are adequate supplies of protective equipment for the nurses during working in the pandemic. The government should also take initiatives to prevent social stigma and uphold the position of healthcare workers as frontline fighters against COVID-19 so that they might not face any emotional abuse for being a healthcare worker when they are working amid COVID-19 pandemic. Since these results pertain to the duration of the pandemic in Bangladesh, broader longitudinal research should be undertaken in the current time to direct policymakers in recognizing the psychological effects of COVID-19.
Limitations
There are some limitations in this study. First, the intrinsic nature of the research is confined to nurses with internet access, as is the sampling technique. Second, the causal explanation was not possible due to the cross-sectional design of the research. Third, this survey screened for symptoms and not a detailed mental health assessment that confirms the diagnosis, so it did not take into account nurses who might have pre-existing mental health issues or who might develop symptoms due to factors other than COVID-19. Fourth, in this study, just under half of the potential respondents did not participate, so there might be more motives for those with symptoms to respond and might over-represent the prevalence of symptoms in the nursing population.
Regardless of the constraints, this study indicates the primary fundamental information on the real degree of psychological symptoms among Bangladeshi nurses and how the mental well-being of nurses is varied during this pandemic.
