Factors Associated with the Mental Health of Health Care Workers Exposed to Pandemic-COVID-19

Background: Pandemic, COVID is spreading like a wild fire and it has already become a global issue. People all over the world are going through mental trauma due to the current situation of the globe. The most vulnerable situation is of the front line volunteers like doctors, health care workers, social workers who are coming in direct contact with the COVID patients and working in highly risky work environment. Since its inception in December 2019, Novel Corona Virus Disease started spreading rapidly both locally and internationally and looking to the adversity of the disease, World Health Organization (WHO) declared it has pandemic. The aim of this paper is to explore the determinants associated with the Mental Health of Health Care Workers (HCW) during the pandemic Novel Coronavirus (COVID-19). Questionnaire was developed having both demographic questions and questions related to mental health. Data was collected from 433 HCWs who were the front-line workers, involved directly in handling these patients. Questionnaire was classified into two parts; one included the demographic questions and the second part included questions related mental health and occupational stress. These HCW were the front line works and were more Original Research Article Yede et al.; JPRI, 33(59A): 568-578, 2021; Article no.JPRI.71079 569 vulnerable and were having the high risk of getting affected. Percentage analysis was used to analyse the demographic data. Exploratory factor analysis was used to explore the dimensions related to mental health and occupational strength. Multi regression model was used to check the impact of emerged factors like increased workload, the continuous contact with COVID-19 patients and emotional aspects to mental health and occupational stress. Results: Value of R 2 obtained was 0.778, which means, the derived factors namely Work pressure, optimism ,Risk factor, Emotional Exhaustion , Self control, Discomfort were able to explain 77.8 % of the dependent variable ‘Mental Health’. All the above factors influence Respondent’s Mental Health, as the significant the factors namely work pressure; risk factor and emotional exhaustion are directly proportional to Mental health. Work pressure is the most influencing factor among it. Optimism, self-control and discomfort are inversely proportional to Mental Health of HCW. Conclusion: Most important emerged from this study was ‘Work Pressure’. Due to the fast spread of this deadly virus, a war like situation has emerged and Health Care Workers are the most vulnerable people as they are serving the patients directly. They are sacrificing their own physical and mental health and are serving the mankind. These people deserves lots of appreciation and salutations.


INTRODUCTION
Novel coronavirus disease (COVID-19) has spread rapidly both locally and internationally, since its inception in December 2019 [1]. Throughout the world, Health Care Workers (HCW) were the front line workers who were involved in the screening and further process of treatments. Hence they all were named as COVID-19 warriors [2][3][4][5]. They risked their own life to provide the Nobel service to the affected patients and discharged their responsibilities like true warriors [6,7]. Under this tremendous crisis situation, these HCW were subjected to mental and physical stress and burnout. They were directly handling these patients and were risking their own life [8,9]. The adverse situations where they were working was leading to occupational stress, emotional exhaustion and uncertainty among HCW [10]. Occupational stress due to COVID-19 was the indicator of mental illness as it may result to anxiety and depression [11][12][13][14]. Infectious nature of the virus and the countless deaths were also having a negative impact on the HCWs [15]. Working conditions through which these HCWs were going through was showing a negative impact on their job satisfaction [16][17][18][19][20]. They were also having a fear of getting infected and hence to maintain the morale level was challenge [21,22]. There is a direct connection between working conditions and mental health and occupational stress. Increased workload, risky conditions and long working hours have a negative effect on mental health [23]. Due to the infectious nature of the virus many were unable to go home and unable to meet their families. This also led to situation of uncertainty and was having a direct impact on their mental health [24]. COVID-19 was first appeared in Wuhan City, in China, in end of 2019 (Wnag C. et al.,2020b). It is an International Public Health Emergency and resulted in psychological issues like stress, depression and anxiety among the population [25]. Previous epidemic studies have proved that, infectious diseases have not only resulted in the physical damages, but have psychopathological issues [9,26]. In case of SARS in 2003, health care workers have shown the symptoms of acute distress [9]. MERS outbreak of 2015 resulted in post-traumatic stress disorder (PTSD), which amplified the problem of absenteeism at workplace [26]. Front line Health Care Workers are more prone to infection as they are in direct contact with the patients [1,27].

Response Rate
In total 450 questionnaires were administered. Out of that 433 was received back. Hence the response rate was as.  To derive the predictive model of Mental Health and also to the most influencing factor, out of the derived factors.

Statistical Techniques Used for Data Analysis
The statistical package used for data analysis was SPSS 21.

Demographic Profiling of the Respondents
Percentage Analysis was done to study the demographic profiling of the respondents.
Demographic variables studied, were gender, martial status, kids, working status of spouse and staying in joint family. 53.58 % were male respondents and 50.47 % were female. 68.36 % were married and 31.64% were single. 56.81% were having kids and 43.19 % were not having kids. 53.58 % were living in joint family and 46.42% were not.  Kaiser-Meyer-Olkin(KMO) and Bartlett's Test value obtained is 0.787. Any value above .5 is acceptable. The value obtained is 0.787, which is above 0.5. Hence factor analysis can be done.
Factor I explained 20.25% of total variance, Factor II explained 14.43%, Factor III explained 9.51 %, Factor IV explained 9.25%, Factor V explained 7.54%, Factor VI explained 6.59 and Factor VI explained 6.11% respectively. Total variance explained by the convergence 28 statements into 7 factors is 73.66 %. These emerged 7 factors were able to explain 73.66% variance. So, there may be the possibility of presence more factors, which will explain the rest of the variance.
28 items got converged into 7 factors and the total variance explained was 73.66 %. This percentage is acceptable. It means the 28 items under study was able to explain 73.66% and still there are other components which contributes to HCW's mental health.
Remaining 26.34 % includes the other components, which may be the scope of further study.

To Derive the Predictive Model of Mental Health
Multi regression model was used to derive the predictive model and also to find the most influencing factor out of it.
Value of R 2 obtained was 0.778, which means, the derived factors namely Work pressure, optimism ,Risk factor, Emotional Exhaustion , Self control, Discomfort were able to explain 77.8 % of the dependent variable 'Mental Health'. All the above factors influence Respondent's Mental Health, as the significant the factors namely work pressure, risk factor and emotional exhaustion are directly proportional to Mental health. Work pressure is the most influencing factor among it. Optimism, self-control and discomfort are inversely proportional to Mental Health of HCW.

CONCLUSION
Study explored the Factors Associated with the Mental Health of Health Care Workers Exposed to Pandemic-Covid-19. Exploratory Factor Analysis was used, and 28 items converged into 7 factors. The factors thus derived was named as Anxiety, Work Pressure, Emotional Exhaustion, Risk Factor, Optimism, Self Control and Discomfort. Derived seven factors together was explained with 73.66 % variance. ultiple Regression Model helped to the predict the influence of the identified factor and also helped to identify the most rominent factor. Most important emerged from this study was 'Work Pressure'. Due to the fast spread of this deadly virus, a war like situation has emerged and Health Care Workers are the most vulnerable people as they are serving the patients directly. They are sacrificing their own physical and mental health and are serving the mankind. These people deserves lots of appreciation and salutations.

CONSENT
As per international standard or university standard, respondents' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
As per international standard or university standard ethical approval has been collected and preserved by the authors.