Study design, setting, and participants
A cross-sectional study was conducted using an anonymous online survey to collect data between 21 May and 7 July 2020. The time of disseminating the survey coincides with the peak of the first COVID-19 wave, which was the most stressful period facing healthcare providers because of the increased workload and the lack of knowledge and experience in dealing with confirmed and suspected cases of the COVID-19 virus. The survey link was sent directly to the healthcare workers in the facilities dedicated to treating COVID-19 patients. The facilities included in our sample were among the first isolation hospitals opened at the beginning of the first COVID-19 wave in Cairo, Helwan, Aswan, Marsa Matrooh, Luxor, Alexandria-Asyout-Al-Qalubia, Al-Menia, Al-Behera, and Al-Gharbia. They included both governmental and university isolation hospitals. In addition, one fever hospital (Hommiat Aswan) and one chest hospital (Al-Maamora) were included. Those hospitals were chosen as the psychosocial support offered by GSMHAT was available in them.
The sample included doctors, nurses, and lab technicians. Convenient sampling was used, and 118 responses were received from participants during the period of the study.
Data collection tools
A Google form questionnaire was created to collect the data from the participants. The designed form included informed consent, socio-demographic data of the participants, the Arabic version of the Perceived Stress Scale (PSS-10), and questions about possible predictors of stress during their practice. The informed consent explained the aim of the study, the anonymity, and the confidentiality of the survey. It also explained that the data would be used for research and improving the participants’ work conditions, then it was followed by a request for agreement to participate. The socio-demographic data collected included age, sex, place of work, and specialty.
The Arabic version of the Perceived Stress Scale (PSS-10) [14, 15] is a widely used self-reported scale for measuring the perception of stress. The scale consists of 10 items that measure how some life events are perceived as stressful. It asks about thoughts and feelings during the last month. Participants determine the frequency of experiencing specific items on a Likert scale from 0 to 4, where 0 means never, and 4 means very often. The score was obtained by reversing the score of the four positively stated items (item nos.4, 5, 7, and 8) then summing the score of all items. A score less than 16 is considered average, from 16-20 is slightly higher than average stress, and above 20 is considered much higher than average perceived stress. High levels of stress are a risk factor to different health problems, which necessitates intervening to reduce stress levels, such as changing lifestyle. The participants were encouraged to follow the instructions of the World Health Organization (WHO) and the General Secretariat of Mental Health (GSMHAT) for healthcare workers to alleviate stress during the pandemic if they are mild to moderately distressed (PSS score below 20). For example, they were encouraged to take time to rest and relax at work or between work shifts. Keeping in touch with family and friends, talking about their thoughts and feelings can also be beneficial. They were also encouraged to maintain their daily routine as much as possible (meals and sleep) and to do other activities as exercising and reading. Lastly, they were advised to avoid unhealthy coping methods as using tobacco, alcohol, or drugs. Those who were severely stressed (PSS score above 20) were encouraged to ask for specialized psychological support service through the hotline dedicated to the psychological support of medical staff offered by the GSMHAT.
Questions about the possible predictors of stress included lack of a clear protocol for dealing with positive cases or suspected or undiagnosed cases, unavailability of self-protective clothing or insufficient training on wearing and taking them off, stress due to dealing with critical situations, stress due to increased workload or being assigned to new tasks not related to their specialty and experiences, fear of becoming infected with the virus or, fear of transmitting the virus to their families, in addition to mentioning other reasons.
Statistical analysis
Data were analyzed using the Statistical Package for the Social Sciences version 21 (SPSS 21). Mean and standard deviation were used for describing the continuous data, while number and percentage described the categorical data. Comparisons between groups of categorical data were made using the chi-square test. Multivariate stepwise linear regression analysis was performed for detecting predictors of stress among the participants.