Somatoform Symptoms among Frontline Health-Care Providers during the COVID-19 Pandemic

To the editor,

Globally, frontline healthcare providers (HCPs) are utmost prone to psychological symptoms during a pandemic. ¹ Numerous studies have reported the prevalence of adverse psychological outcomes, namely, anxiety, depression, stress, burnout, and post-traumatic stress disorders among the frontline HCPs who are at battlefront against COVID-19.^2,3 A pandemic of this magnitude has the potential to afflict long-lasting agony on the personal life and work spheres of those affected. ⁴ Every nation relies on the strength and caliber of its health workforce to combat pandemics, and exploring mental health issues among this group is of paramount importance. However, somatoform disorders are less explored among the frontline HCPs during the COVID-19 pandemic. Somatoform disorder is an enduring phenomenon, which may lead to social and occupational misery and increased health-care utilization. As of January 3, 2021, no studies have explored somatoform symptoms among frontline HCPs from India. Hence, our study aimed at evaluating the prevalence of somatoform symptoms among frontline HCPs in India.

Methodology

After obtaining permission from the Institute Ethics Committee, an online survey was conducted from June 01 to July 25, 2020, among frontline HCPs, that is, doctors and nurses, working in India, by adopting the snowball sampling technique. Tools included were study participant profile, the Screener for Somatoform Disorder (SSD) ⁵ to assess somatoform symptoms, and depression, anxiety, and stress scale (DASS-21) ⁶ to assess other psychological symptoms.

SSD consists of 12 dichotomous items, wherein each participant chooses “yes” or “no” for each item. The participant has to choose the “yes” option if the problems had lasted three or more months, and choose “no” otherwise. If the participant reported at least 3 of the items as “yes,” they are regarded to have screened positive.

Results

Out of the 803 responses received, 700 were included in the analysis after removing duplicates and incomplete responses. The overall prevalence of psychological symptoms was 49.7% (n = 348), whereas 28.8% (n = 202) reported multiple psychological symptoms (screened positive for more than one symptom, i.e. depression, stress, anxiety, and somatoform symptoms). The most frequent presentation was depression with anxiety, which was followed by somatoform symptoms along with depression, stress, and anxiety (Figure 1).

The prevalence of somatoform symptoms was 27.4 % (n = 192), of which 10.9% (n = 76) had screened positive for somatoform symptoms without any other psychological symptoms. The remaining 16.5% (n = 116) had multiple psychological symptoms along with somatoform symptoms (Figure 1).

Figure 1.

Prevalence of Somatoform Symptoms Comorbid with Other Psychiatric Disorders

In the 27.4% (n = 192) HCPs who screened positive for somatoform symptoms, the most prevalent somatoform symptoms were muscle ache (66.1%), back pain (63%), headache (57.8%), heaviness or lightness in the head (51.6%), abdominal discomfort (49%), fatigue (48.4%), feeling of heaviness or lightness in arm or leg (42.2%), heart pounding (39.6%), and dizziness (29.2%). Further analyses revealed that somatoform symptoms were more prevalent among females (33.5%) than male (19.8%) HCPs.

Discussion

The prevalence of somatoform symptoms in the present study is higher than that in the findings of a study from Italy, which reported muscle tension among 48.4% and stomach upset among 37.3% HCPs. ⁷ The heightened prevalence of somatoform symptoms in the current study may be attributed to the fact that the study was conducted when COVID-19 positive cases in India were rising swiftly and most hospitals were running short of vacant beds for coronavirus patients. The current study finding of comorbidity of somatoform disorder along with anxiety or depression or stress disorder has been reported in various studies.^8–10 This is because most of the depression or anxiety cases have a dual diagnosis with pain disorder or somatoform disorder. Further analyses revealed that somatoform disorder was more prevalent among females (33.5%) than male (19.8%) HCPs, as reported in earlier studies. ¹¹

The working group of World Health Organization, has proposed a new and much simplified category of bodily distress disorder (BDD), which replaces all of ICD-10 categories within the group of somatoform disorders (F45.0) and, to a large extent, neurasthenia (F48.0), bringing these together under a single category. The only ICD-10 somatoform condition excluded from BDD is hypochondriasis (F45.2).

Conclusion

During a pandemic situation, the frontline HCPs are prone to the somatoform symptoms with specific group of mental disorders such as depression, anxiety, and stress. Identifying somatoform symptoms among HCPs could help design timely mental health interventions to mitigate adverse psychosocial outcomes and enhance their mental resilience.