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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 22  |  Issue : 1  |  Page : 68-73

A cross-sectional study of psychological distress among doctors' spouses during COVID-19


1 Junior Consultant, Department of Psychiatry, Indlas VIMHANS Hospital, Vijayawada, Andhra Pradesh, India
2 Senior Consultant Cum PG Teacher, Department of Psychiatry, Indlas Vimhans Hospital, Vijayawada, Andhra Pradesh, India
3 Junior Consultant, Indlas Child Guidance Clinic, Indlas Vimhans Hospital, Vijayawada, Andhra Pradesh, India
4 Director and Head, Department of Psychiatry, Indlas VIMHANS Hospital, Vijayawada, Andhra Pradesh, India

Date of Submission15-Apr-2021
Date of Acceptance28-Apr-2021
Date of Web Publication01-Jun-2021

Correspondence Address:
Dr. Sripathi Santhosh Goud
Indlas VIMHANS Hospital, Vijayawada - 520 002, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amh.amh_51_21

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  Abstract 


Introduction: Coronavirus disease 2019 (COVID-19) infection and subsequent lockdown restrictions brought drastic changes in the lives of the people. Doctors' community led the fight against COVID-19 as frontline warriors leaving their families at home for prolonged periods. The psychological issues among the family members, particularly spouses of doctors, are significantly high and need special attention.
Aims: We aimed to assess the level of psychological distress among doctors' spouses and the possible relationship between different variables and the level of the distress.
Materials and Methods: The study was conducted in online mode using chain-referral sampling method. Sample size was 120 and comprises doctors' spouses who were not related to medical field. Those who were working in medical field or having any past psychological illness were excluded from the study. A semi-structured pro forma was used to collect the basic demographic details, and Kessler's Psychological Distress Scale (K10) was used to rate psychological distress.
Results: 72.5% of the study population had reported psychological distress, and half of these participants reported severe psychological distress. Age was the single variable that had significance (P < 0.1), whereas other variables did not show statistically significant values.
Conclusion: Psychological distress is much higher compared to the general population in the spouses of the doctors. In long run, this may result in psychological illnesses such as depression and anxiety disorders. As a special group, these require targeted interventions and care for the prevention of severe mental health problems.

Keywords: COVID-19, doctors' spouses, psychological distress


How to cite this article:
Goud SS, Indla V, Deshpande M, Reddy IR. A cross-sectional study of psychological distress among doctors' spouses during COVID-19. Arch Ment Health 2021;22:68-73

How to cite this URL:
Goud SS, Indla V, Deshpande M, Reddy IR. A cross-sectional study of psychological distress among doctors' spouses during COVID-19. Arch Ment Health [serial online] 2021 [cited 2021 Nov 28];22:68-73. Available from: https://www.amhonline.org/text.asp?2021/22/1/68/317422




  Introduction Top


The coronavirus disease 2019 (COVID-19), as named by the World Health Organization (WHO), first emerged as unknown pneumonia cases in Wuhan in late December 2019.[1] This outbreak had spread substantially throughout the world which was declared as a public health emergency of international concern on January 30, 2020, and as a pandemic by the WHO on March 11, 2020.[2],[3] In India, the first confirmed case of COVID-19 infection was reported on January 27 in Kerala.[4] On March 12, a 76-year-old man from Karnataka with a travel history to Saudi Arabia became the first COVID-19 fatality of India.[5] As part of the containment initiative, India was placed on a total lockdown from March 25, 2020.[6]

Medical professionals are at enhanced risk of exposure and contracting the infection (roughly 33 times) and chances of transmitting to their loved ones. There is a twofold increase in family members of health-care professionals getting admitted with COVID-19 infection compared to the general population.[7] In a survey conducted by Que et al., 2020, it was found that when compared to the general public, workers in the health-care field who are at constant risk of COVID-19 infection are particularly stressed because of their relatively direct exposure, inadequate protective facilities, excessive work, perceived opinions in the form of stigmatization, necessary quarantine, and sometimes inadequate support of the family.[8]

Doctors experience a high level of work stress even under normal circumstances, but many would be reluctant to disclose or seek help due to stigma. The COVID-19 crisis placed additional pressure on doctors which brought a greater risk of psychological distress for them.[9] This directly affects the mental health of the family members of the doctors, in particular of their spouses who are the primary caregivers of emotionally overburdened doctors.

Psychological distress is defined as a state of emotional suffering typically characterized by symptoms of depression and anxiety. Risk factors include stress-related and sociodemographic factors and inadequate inner and external resources.[10]

Although a great deal of research has documented psychological distress among the general public and health-care workers during pandemics, much less is known about the well-being and mental health of their family members, particularly their spouses. The stress levels or the consequent psychological effects it could have in spouses have not been paid enough attention. Hence, this study was conducted to assess the level of psychological distress among the doctors' spouses during the COVID-19 period and therefore provide a basis for implementing relevant policies to cope with this challenge efficiently and effectively.


  Materials and Methods Top


This study was a cross-sectional study done through online mode. After obtaining approval from the institutional ethics committee, the study was conducted from August 1, 2020, to August 31, 2020. Study participants were doctors' spouses who were not related to medical field. The total sample size was 120. Google forms were generated and circulated through WhatsApp to them and requested to fill the forms after obtaining informed consent. The age group of 25–55 years, those who have internet facilities, use WhatsApp, and can read and understand basic English were included in the study. Those who were working in medical field, who were not willing to give consent, or who were already suffering from any kind of psychological illness were excluded from the study.

A semi-structured pro forma generated through Google forms was used to collect sociodemographic data.

Kessler's Psychological Distress Scale (K10) was used to assess psychological distress. The K10 is the most popular tool for screening for psychological distress in the general population.[11]

K10 comprises ten items, rated on five-point Likert-type scales, which indicate the degree of psychological distress prevalent among persons in the past 4 weeks. K10 has excellent internal consistency and reliability (Cronbach's alpha = 0.93).[12]

The 2001 Victorian Population Health Survey adopted a set of cutoff scores that may be used as a guide for screening for psychological distress.[13]

Statistical analysis

Descriptive statistics were calculated for sociodemographic variables as frequencies and percentages.

The one-way analysis of variance was employed to determine whether there are any statistically significant differences between the means of three or more independent (unrelated groups).

Chi-square/Fisher's exact test was used to find the significance of study parameters on a categorical scale between two or more groups. Fisher's exact test was used when cell samples were very small.

Significant figures

  • +Suggestive significance (P value: 0.05 < P < 0.10)
  • *Moderately significant (P value: 0.01 < P < 0.05)
  • **Strongly significant (P value: P <0.01).


The Statistical Package for the Social Sciences IBM SPSS for Windows version 22.0 (Armonk, NY, USA) and R environment version 3.2.2 (Vienna, Austria) were used for analysis of the data.


  Results Top


Sociodemographic characteristics of doctors' spouses

Total 120 responses were received. In this study, majority of the population were females (80.8%, n = 97), and the mean age of the participants was 38.6 years (standard deviation = 7.5); 65% (n = 78) were graduates, 50% (n = 60) were homemakers, 90% (n = 108) were from nuclear families, 49.2% (n = 59) were married for < 10 years, 36.7% (n = 44) had 1 kid, and 40.8% (n = 49) had 2 kids. The study sample comprised 48.3% (n = 58) of participants whose partners were working as government doctors and 51.7% were private practitioners. 29.2% (n = 35) of the partners of the participants were general physicians, 15% (n = 18) were anesthetists, and 15% (n = 18) were general surgeons [Table 1] and [Table 2].
Table 1: Sociodemographic profiles of doctors' spouses studied (n=120)

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Table 2: Sociodemographic profiles of doctors' spouses studied (n=120)

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Level of psychological distress

27.5% (n = 33) of the participants reported no distress, 18.3% (n = 22) reported mild distress, 5.7% (n = 7) reported moderate distress, whereas 48.3% (n = 58) reported severe distress [Table 3]. When baseline variables are compared with K10 scores, age of the participants is the only variable that had shown significant statistical value (P < 0.1) on the Chi-square test, whereas other variables such as gender, education, type of profession, type of family, and number of kids had shown no significance [Table 4] and [Table 5].
Table 3: K10 score - frequency distribution of doctors' spouses studied (n=120)

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Table 4: Comparison of baseline variables in relation to Kessler's Psychological Distress Scale score of doctors' spouses studied

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Table 5: Comparison of baseline variables in relation to Kessler's Psychological Distress Scale score of doctors' spouses studied

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  Discussion Top


In our study, 72.5% of the participants reported psychological distress which was almost double the distress reported in the general population (38.5%) by Sathe et al.[14] In another study done in West Bengal by Chakraborty and Chatterjee, 64.9% of the study participants reported that COVID-19 had affected their mental status to some extent whereas 24.5% reported feeling depressed.[15] Ramasubramanian et al. found 2.7% severe psychological distress among the general population in their study done in the state of Tamil Nadu.[16] The findings suggest that the doctors' spouses were having greater psychological distress than the general population.

Most of the study participants in the current study were females (80.8% n = 97). Seventy-four percent of female spouses of male doctors and 65% of male spouses of female doctors reported psychological distress. Sathe et al. in their study found that female gender was significantly associated with psychological distress, but we could not find this association in our study.[14]

Homemaker's role combined with the extra pressure of managing the kids due to the closure of schools and managing household chores alone due to unavailability of maids during COVID-19 could be a factor for homemakers reporting much psychological distress (76%). As most of the participants were from nuclear families, this could further explain the high distress levels among them.

Two-third of the study population were in the age groups of 30–50. Age of the spouse was the single variable in our study which had shown statistical significance in distress score (P < 0.1). Age, income, and marital status were the variables found to be having a significant relationship with psychological distress in the study done by Ramasubramanian et al.[16] Although parenthood had not shown a significant difference in K10 scores in our study, Herman-Stahl et al. found that odds of having serious psychological distress were lower among parenting adults than nonparenting adults.[17] The type of practice of the doctor or their specialty had no association with K10 scores.

Spouses of the doctors have to play the role of caregivers for their stressed out doctor partners as many studies reported rise in mental health issues in doctors during COVID-19. Doctors are generally regarded by their colleagues as being difficult patients as they seldom follow the treatment advice given by their colleagues.[18] The spouses of the doctors also have fear of financial security and worrying about the future of their kids if something happens to their doctor partners. Apart from taking care of their partners, spouses of the doctors, particularly those who are homemakers, have to manage the things at home all by themselves. A study conducted in the UK during lockdown by Xue and McMunn concluded that juggling household work with homeschooling and child care as well as extra housework due to lockdown is likely to lead to poor mental health for people with families, particularly for lone mothers.[19] All these factors along with other COVID-19-related stressors have put enormous pressure on the spouses of the doctors resulting in severe psychological distress.

This study is an attempt to assess psychological distress in the doctors' spouses. Family members, particularly spouses of other health-care workers, police, and municipal employees, are also at increased risk of psychological distress. Future studies should focus on this population and include other socioeconomic variables that will give greater insights into this topic.

Limitations

Several limitations of this study should be considered. As the sample size in our study is small, the generalization of the findings should be done carefully. The comparison between our results and those of earlier studies should be made with caution due to the different study setups, population, and scales used. The analyses were based on cross-sectional data; thus, they represent a single snapshot in time and cannot capture the dynamic nature of psychological distress. Data in our study are self-reported. Stigma may hinder reporting of psychological distress.


  Conclusion Top


The findings of the current study have shown that there is a significant level of psychological distress among spouses of the doctors which is much more than the general population. Although there are supportive programs by various governmental and nongovernmental organizations, a wide range of other policy decisions need to be taken by governments keeping the needs of this special group of population. Measures to assure financial security, planning work schedules of the doctors with enough breaks to spend time with their family members, allowing digital meetings with the family during working hours, and giving relaxations to spouses of frontline workers to travel and meet their family members could help to reduce the distress.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Galbraith N, Boyda D, McFeeters D, Hassan T. The mental health of doctors during the COVID-19 pandemic. BJPsych Bull 2021;45:93-7.  Back to cited text no. 9
    
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Drapeau A, Marchand A, Beaulieu Prevost D. Epidemiology of psychological distress. In: LAbate PL, editor. Mental Illnesses – Understanding, Prediction and Control. Rijeka: InTech; 2012. p. 134-55.  Back to cited text no. 10
    
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Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184-9.  Back to cited text no. 11
    
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Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002;32:959-76.  Back to cited text no. 12
    
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Victorian Population Health Survey. Melbourne: Department of Human Services, Victoria; 2001.  Back to cited text no. 13
    
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Sathe HS, Mishra KK, Saraf AS, John S. A cross-sectional study of psychological distress and fear of COVID-19 in the general population of India during lockdown. Ann Indian Psychiatry 2020;4:181-9.  Back to cited text no. 14
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15.
Chakraborty K, Chatterjee M. Psychological impact of COVID-19 pandemic on general population in West Bengal: A cross-sectional study. Indian J Psychiatry 2020;62:266-72.  Back to cited text no. 15
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16.
Ramasubramanian V, Mohandoss AA, Rajendhiran G, Raja P, Pandian S, Ramasubramanian C. Statewide survey of psychological distress among people of Tamilnadu in the COVID-19 pandemic. Indian J Psychol Med 2020;42:368-73.  Back to cited text no. 16
    
17.
Herman-Stahl M, Ashley OS, Penne MA, Bauman KE, Weitzenkamp D, Aldridge M, et al. Serious psychological distress among parenting and nonparenting adults. Am J Public Health 2007;97:2222-9.  Back to cited text no. 17
    
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Harari E. Pathalogical grief in doctors' wives. Br Med J (Clin Res Ed) 1981;282:33-5.  Back to cited text no. 18
    
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Xue B, McMunn A. Gender differences in unpaid care work and psychological distress in the UK Covid-19 lockdown. PLoS One 2021;16:e0247959.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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