Generalized Anxiety Disorder among Paediatricians During the COVID-19 Pandemic

Background: COVID-19 pandemic has put healthcare professionals at risk of developing mental health issues. Primarily, because of their increased chances of being affected and fulfilling their job commitments despite insufficient knowledge about the new disease and its management. Hence, it is essential to assess the burden of such mental health issues amongst healthcare providers. Objective: To determine the frequency and severity of generalized anxiety disorder among paediatricians during the COVID-19 pandemic. Methods: Cross-sectional observational study conducted in Department of Paediatrics (unit 1), King Edward Medical University/ Mayo Hospital Lahore, duration of 03 months. After IRB approval, an online survey form was developed based on GAD-7 Scale as an assessment tool for assessing anxiety among paediatricians. A survey form was dispersed using social media to pediatricians of different ages and working statuses. The responses were recorded and assessed using SPPSS. Quantitative variables (age, GAD-score) were summarised as mean and standard deviation. Qualitative variables (gender, place of work, individual GAD-component score) were summarised as frequency and percentages. Results: A total of 147 responses were received, out of which 13 were excluded. The remaining 134 were analysed through SPSS 26. Out of these, 106 (79.1%) turned out to be suffering from new-onset anxiety. Amongst these 106 paediatricians, 69 (65.1%) were females, and 37(35.9%) were males (p-value 0.013). The severity of anxiety was mild, moderate and severe in 62 (46.3%), 37 (27.6%) and 7 (5.2%) of paediatricians, respectively. Conclusion: More than three-fourths of paediatricians had higher GAD 7 scores during the COVID-19 pandemic suggesting generalized anxiety disorder.


Introduction
A new strain of coronavirus named as 2019-NCOV/ COVID-19 appeared in Wuhan, China, at the end of 2019.Health professionals worldwide are highly 1 vulnerable to acquiring and transmitting COVID-19.Increased work stress of health professionals can lead to weakened immune systems, and management of patients intimately can result in exposure to a higher viral load.Despite delivering selfless service on behalf of their communities, health professionals face many death during plague outbreaks in medieval Europe, during a yellow fever outbreak in Philadelphia in 1793, during the Ebola epidemic in 2014, and now as well Anxiety is an emotion we all experience in a situation that is threatening or difficult.The anxiety abates when you get used to the situation, when the situation changes, or if you just leave.It is generally expected from physi-5 cians to quietly endure physical or emotional suffering.However, the COVID-19 pandemic inflicted a substantial mental toll on health professionals, especially in 6 frontline health professionals and nursing staff.Paediatricians will be dealing with the short-term effects of the COVID-19 pandemic and the long-term indirect impact it will incur on children even after the pandemic is over.The prevalence of anxiety was found to be 14.0% in pediatric medical staff in Jiangsu province of China Another Pakistani study was able to prove that greater exhaustion, greater family strain, and reduced feelings of protection impacted on levels of anxiety among physi-9 cians.Similarly an elaborate study conducted in a large tertiary care center in Lahore, Pakistan concluded that, high psychological distress was experienced by HCWs 10 caring for COVID-19 patients.Paediatricians will be dealing with the short-term effects of the COVID-19 pandemic and the long-term indirect impact it will incur on children even after the pandemic is over.Therefore, this study was planned to determine the frequency and severity of generalized anxiety disorder among paediatricians during the COVID-19 pandemic and also no local study was available in which paediatricians only were taken into consideration.This study was carried out despite the fact that many studies were already being published while we were collecting the data.One, only paediatricians were included in the study as although children were not among the most effected population during the pandemic but paediatrians will be dealing with the long term effects of this pandemic on the paediatric population in terms of missed vaccinations, missed school days, behavioural problems while away from school and peers, and emerging issues like MIS-C.

Methods
Institutional Review Board of King Edward Medical University approved the study (IRB no.380/RC/KEMU dated: 16/06/2020).This cross-sectional, observational study was conducted by the Department of Paediatrics, King Edward Medical University / Mayo Hospital Lahore from June 2020 to August 2020.The sample size was not predetermined.Due to lockdown and social distancing, the paediatricians were approached through an online survey form generated by incorporating the Generalized Anxiety Score (GAD 7).The GAD-7 score was calculated by assigning scores on a 4-point Likert scale: 0 (not at all), 1 (several days), 2 (more than half the days), and 3 (nearly every day), and adding together the scores for the seven questions.Scores of 5, 10, and 15 were taken as the cut-off points for mild, moderate and severe anxiety respectively.Using the threshold score of 10, the GAD-7 has a sensitivity of 89% and a 11 specificity of 82% for GAD.A few more questions were asked from the participants regarding their work performance along with the GAD 7 scale during the initial stages of the pandemic.Paediatricians from both private and public institutions were approached.Demographic variables included age, gender, place of work, and designation was recorded.Responders who already suffered GAD before the onset of the COVID-19 pandemic as per their provided information were excluded.
Data was analyzed through SPSS 26.0.Quantitative variables (age, GAD-score) were summarised as mean and standard deviation.Qualitative variables (gender, place of work, individual GAD-component score) were summarised as frequency and percentages.Data was stratified based on age, gender, and seniority.Chi-square test was applied and a p-value of < 0.05 was considered statistically significant.

Results
A total of 147 responses were obtained during the study period.Thirteen paediatricians were excluded because of generalised anxiety disorder even before the pandemic.Hence, 134 participants were included in the final data analysis.Fifty-four (40.3%) respondents were males while 80 (59.7%) were females.Out of the total of 134 respondents, 106 (79.1%) were found to have Generalized Anxiety Disorder; 69 (69.1%) females and 37 (30.9%)males (p-value 0.013).Of 106 respon- This study was conducted in the first wave when there was a shortage of personal protective equipment, very limited knowledge about the new disease and its management, and no vaccine was licensed.But it's a way forward to a new study in the second wave to find any difference from the previous one, especially with new vaccines being approved.

Conclusion
More than three-fourths of paediatricians were found to have new-onset anxiety disorder during the COVID-

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during an outbreak of COVID-19.Hence, it seemed essential to determine the mental wellbeing of paediatricians in Pakistan also.According to a study conducted in Pakistan, paediatric residents experienced substantial 8 physical, emotional and social stress during COVID-19.

Table 1 :
Distribution of GAD Variable Responses According to Age and Gender 16to direct exposure to COVID-19 infected patients.Almater et al also found anxiety levels to be high among 17 female ophthalmologists.Filho et al demonstrated a positive relationship between female medical students 18 and higher GAD-7 scores with a p-value of 0.015.
19 pandemic, but with varying severity regarding the gender and the age group.The Institutional review board approved the study vide letter No. 380/ RC/KEMU.Data collection and initial draft of manuscript AS: Critically review for important intellectual contents SA: Data interpretation, proof reading and approval of final draft MHH: Supervised all steps and critical review of the article SA: conceived the idea, defended the ethical approval, data acquisition and interpretation, manuscript writing and final approval of the draft SS: Data interpretation, proof reading and approval January -March 2024 | Volume 30 | Issue 01 | Page 29 of final draft MN: