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\begin{document}

\title{Anxiety and Depression Scores in Maternity Healthcare Workers during the
Covid-19 Pandemic}



\author[1]{Gillian Corbett}%
\author[1]{Sarah Milne}%
\author[2]{Shuja Reagu}%
\author[3]{Suruchi Mohan}%
\author[4]{Mark Hehir}%
\author[1]{Stephen Lindow}%
\author[1]{Michael O Connell}%
\affil[1]{Coombe Women and Infants University Hospital}%
\affil[2]{Hamad Medical Corporation}%
\affil[3]{Weill Cornell Medical College in Qatar}%
\affil[4]{Columbia University, College of Physicians and Surgeons}%


\vspace{-1em}



  
  \date{May 14, 2024}


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\emph{Anxiety and Depression Scores in Maternity Healthcare Workers
during the Covid-19 Pandemic}Gillian A. Corbett\textsuperscript{1},
Sarah J. Milne\textsuperscript{1}, Suruchi Mohan\textsuperscript{2},
Shuja Reagu\textsuperscript{3,} Stephen W. Lindow\textsuperscript{1},
Mark P. Hehir\textsuperscript{1}, Michael P
O'connell\textsuperscript{1}.

\textbf{Affiliations}

\textsuperscript{1}Department of Obstetrics and Gynaecology, Coombe
Women and Infants University Hospital, Cork Street, Merchants Quay,
Dublin 8, Ireland. D08 XW7X\textsuperscript{2} Sidra Medicine, Doha,
Qatar\textsuperscript{3}Hamad Medical Corporation, Doha, Qatar

\textbf{Corresponding Author}

Dr Gillian Corbett.

Department of Obstetrics and Gynaecology, Coombe Women and Infants
University Hospital, Cork Street, Merchants Quay, Dublin 8, Ireland. D08
XW7X Tel: +353 (1) 408 5200

Email: gcorbett@coombe.ie

\textbf{Word Count:} 598

\textbf{Financial Disclaimers/Conflict of Interest:} None

\emph{}

\emph{INTRODUCTION}

Severe-Acute-Respiratory-Syndrome-CoronaVirus-2 (SARSCoV-2/Covid-19)
increases morbidity in healthcare workers (HCWs), who make up a
significant proportion of infections, hospital admissions and
deaths\textsuperscript{1}. Aside from physical illness, covid-19
significantly affects psychological health in the general population, in
pregnant women\textsuperscript{2} and HCWs. Working on the frontline
compounds the psychological burden on providers caring for patients with
Covid-19\textsuperscript{3-4}. It is essential that healthcare
institutions understand the stress their staff are experiencing, which
may translate into anxiety and depressive symptomatology. To this end we
assessed anxiety and depression among HCWs due to the Covid-19 pandemic.

\emph{METHODS}

A prospective study was performed on HCWs at a tertiary-level university
hospital in Dublin, Ireland. The Coombe Women and Infants University
Hospital (CWIUH) is one of the largest providers of women's healthcare
in Europe, delivering almost 9000 babies annually and serving the
diverse urban population of this European capital city.

The anonymous online survey was distributed to HCWs in all departments
of the hospital.

The Generalized-Anxiety-Disorder-7(GAD-7)\textsuperscript{5} and
Patient-Health-Questionnaire-9(PHQ-9)\textsuperscript{6} scores were
used to analyze severity of anxiety and depression (A\&D). The composite
questionnaire included questions assessing previous mental health
status, coping strategies and support mechanisms.

Survey responses were analyzed using statistical software
(IBM-SPSS-Version-24.0). Median and range PHQ-9 and GAD-7 scores were
compared using Mann-Whitney-U or Kruskal-Wallis-H tests. Due to rapid
emergence of the pandemic, the study had executive ethical approval.

\emph{RESULTS}

From 20\textsuperscript{th} April to 5\textsuperscript{th} May 2020, 252
hospital staff completed the questionnaire. Nursing (35\%) and
administrative staff (22\%) made up the largest proportion of the cohort
followed by medical staff(15\%).

HCW mental health has significantly deteriorated since the onset of
Covid-19. 46.6\% reporting their mood has worsened. HCWs reported
significant levels of A\&D with 20.3\% having moderate to severe
depression and 21.0\% having moderate to severe anxiety(Table 1). A\&D
scores significantly varies with age(Table 2), with higher scores in
younger age groups(GAD-7 9.00vs1.00;p=0.000, PHQ-9
9.00.vs.0.5;p=0.0001). Anxiety scores were higher in women but
depression scores were similar between genders (GAD-7 5.00vs.2.00;
p=0.027; PHQ-9 4.00vs.3.00;p=0.144). A\&D scores were higher amongst
administrative staff than medical staff(GAD-7 7.00vs.3.00,p=0.001; PHQ-9
6.00vs.2.00,p=0.010)(Table 2).

When questioned on social isolation, 44\%(112/252) of staff reported
loneliness, 35\%(88/252) felt low due to limitation of activities,
44\%(110/252) felt low from being separated from their families.
Tensions at home were reported by healthcare workers, with
13.5\%(34/252) reporting tensions with their partner and 19\%(48/252)
reporting tensions with other household members including children.

\emph{DISCUSSION}

While high rates of physical morbidity from Covid-19 amongst HCWs have
been demonstrated, examining the psychological effects of Covid-19 of
HCWs is critical.

Significant proportions of staff are experiencing a deterioration in
their mental health due to Covid-19, with over 20\% having moderate to
severe depression and 20\% with moderate to severe anxiety.

Subgroup analysis revealed variations in psychological distress. A\&D
scores were higher among administrative staff when compared with
front-line medical staff, with higher anxieties scores in female HCWs.
Despite younger people having better prognosis than their older
counterparts, scores were significantly higher in younger HCWs. Older
colleagues may have more matured coping mechanisms or younger HCWs may
be worrying about their older relatives, as this group saw in a similar
study on pregnant women\textsuperscript{2}. Increased levels of A\&D in
administrative staff compared to front line health care providers may
represent a rationalization of risk in doctors and nurses/midwives as
part of their professional training.

While HCWs care for patients during this crisis, we must recognize that
HCWs are not immune to significant psychological distress. As the
pandemic progresses, the psychological burden is likely to worsen.
Recognizing this can aid healthcare leaders to support HCWs, prevent
burnout and retain their confidence as we deal with the ongoing
pandemic.

\textbf{Author contributorship:}

The study concept was conceived by MPOC and SWL. Study was designed by
SWL MPH, SM, SR and GAC. Data collection was performed by GAC and SJM,
and was analysed by GAC. The manuscript was drafted by GAC and edited by
SJM, SM, SR, MPH, SWL and MPOC.

\textbf{Conflict of Interest:}

The authors have no conflicts of interest to disclose.

\textbf{Financial Disclaimers:}

None.

\textbf{Ethics approval:}

Suspension of institutional research ethics committee meetings due to
the Covid-19 outbreak meant that approval for the study was granted on
8\textsuperscript{th} April 2020 by the Coombe Women and Infants
University Hospital clinical governance board and executive committee.

\textbf{References}

Health Do. Latest Updates on COVID-19 (Coronavirus). In. gov.ie25th
April 2020..

Corbett GA, Milne SJ, Hehir MP, Lindow SW, O'Connell MP. Health anxiety
and behavioural changes of pregnant women during the COVID-19
pandemic.\emph{Eur J Obstet Gynecol Reprod Biol.} 2020.

Lai J, Ma S, Wang Y et al. Factors Associated With Mental Health
Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019.
JAMA Netw Open 2020 Mar 2;3(3):e203976.

Wang C, Pan R, Wan X, et al. Immediate Psychological Responses and
Associated Factors during the Initial Stage of the 2019 Coronavirus
Disease (COVID-19) Epidemic among the General Population in
China.\emph{Int J Environ Res Public Health.} 2020;17(5).

Spitzer RL, Kroenke K, Williams JB, L\selectlanguage{ngerman}öwe B. A brief measure for
assessing generalized anxiety disorder: the GAD-7. \emph{Arch Intern
Med.} 2006;166(10):1092-1097.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief
depression severity measure. \emph{J Gen Intern Med.}2001;16(9):606-613.

\textbf{Table caption list.}

Table 1. Healthcare workers participant demographics and health
anxieties influential factors

Table 2: Variation in GAD-7 and PHQ-9 scores with baseline
characteristics

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\verb`Table 2.docx`  available at \url{https://authorea.com/users/324567/articles/452736-anxiety-and-depression-scores-in-maternity-healthcare-workers-during-the-covid-19-pandemic}

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