Factors Associated with Mental Health Outcomes in Oman during COVID19: Frontline vs Non-frontline Healthcare Workers

ABSTRACT

OBJECTIVEThis study aims to assess and compare demographic and psychological factors and sleep status of frontline HCWs in relation to non-frontline HCWs DESIGN, SETTINGS, AND PARTICIPANTSThis cross-sectional study was conducted using an online survey from the 8th to the 17th of April 2020 across varied health care settings in Oman accruing 1139 HCWS. MAIN OUTCOMES AND MEASURESMental health status was assessed using Depression, Anxiety, and Stress Scales (DASS-21), and insomnia was evaluated by the Insomnia Severity Index (ISI). Samples were categorized into the frontline and non-frontline groups. Chi-square, odds ratio, and independent t-tests were used to compare groups by demographic and mental health outcomes. ResultsThis study included 1139 HCWs working in Oman. There was a total of 368 (32.3%), 388 (34.1%), 271 (23.8%), and 211 (18.5%) respondents reported to have depression, anxiety, stress, and insomnia, respectively while working during the pandemic period. HCWs in the frontline group were 1.4 times more likely to have anxiety (OR=1.401, p=0.007) and stress (OR=1.404, p=0.015) as compared to those working in the non-frontline group. On indices of sleep-wake cycles, HCWs in the frontline group were 1.37 times more likely to report insomnia (OR=1.377, p=0.037) when compared to those working in the non-frontline group. No significant differences in depression status between workers in the frontline and non-frontline groups were found (p=0.181). CONCLUSIONS AND RELEVANCETo our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on different grades of HCWs. This study suggests that frontline HCWs are disproportionally affected compared to non-frontline HCWs. The problem with managing sleep-wake cycles and anxiety symptoms were highly endorsed among frontline HCWs. As psychosocial interventions are likely to be constrained owing to the pandemic, mental health care must first be directed to frontline HCWs. O_TEXTBOXArticle Summary Methods O_LIThe study accrued 1139 participants of which 574 were working as frontline HCWs (565 non-frontline workers) serving patients with COVID-19 in different categories of healthcare settings in Oman. C_LIO_LIThe following tools used were used alongside the collection of demographic information The depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index. C_LIO_LIStrengths This nationally representative study is the first of its kind to investigate the differences in magnitude and the covariates of stress and distress between frontline and non-frontline healthcare workers in Oman. C_LIO_LILimitations: The use of an online survey and the use of symptom checklists (DASS, ISI) which are typically no match for the gold-standard interviews. C_LIO_LIIt is also not clear whether the observed mental health outcomes constitute adjustment disorders/ acute stress reaction or present a chronic-type and thus irreversible psychological distress. C_LI C_TEXTBOX