Sage Journals: Discover world-class research

Abstract

Introduction

Field midwives (FMs) in Sri Lanka, who care for women and children, were challenged during the COVID-19 pandemic. During COVID-19, the majority of research found that healthcare professionals experienced anxiety and depression.

Objective

This study examined anxiety, depression, and related factors among FMs during the COVID-19 pandemic in Sri Lanka.

Methods

A descriptive cross-sectional approach was used with 145 FMs from randomly selected Medical Officer of Health (MOH) areas in the Matara district. The data were collected by an interviewer-administered questionnaire containing the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 tools. Descriptive statistics, chi-square test, and logistic regression examined and presented the data.

Results

Among the participants, 54.5%, 31.0%, 8.3, and 6.2% experienced minimal, mild, moderate, and severe anxiety. Whereas 46.2%, 32.4%, 17.2%, 1.4%, and 2.8% of the participants had no or minimal, mild, moderate, moderately severe, and severe depression. Being in a family of COVID-19-infected family members, relatives, or friends (OR = 0.33, p = 0.018) and being in a nuclear family (OR = 0.47, p = 0.033) were found to be risk factors against depression while having a history of chronic diseases (OR = 5.87, p = 0.002) and having a sufficient amount of personal protective equipment (OR = 2.52, p = 0.041) were found to be protective. Similarly, having a history of chronic diseases (OR = 4.89, p = 0.002) was found to be protective against anxiety.

Conclusion

The majority of FMs had minimal anxiety and depression during the COVID-19 pandemic. The results will be valuable in formulating policies to support the psychological health of FMs in Sri Lanka.

Keywords

anxiety associated factors COVID-19 depression field midwives Sri Lanka

Introduction/Background

According to the American Psychological Association (American Psychological Association, 2023), anxiety is an emotion characterized by apprehension and bodily sensations of tension in which an individual anticipates impending danger, catastrophe, or misfortune. Anxiety is regarded as a long-acting, future-oriented response to a diffuse danger.

Depression is a widespread and critical medical disorder that has a negative impact on how you feel, think, and act. It is, thankfully, treatable. Depression creates sadness and/or a loss of interest in previously appreciated activities. It can cause many emotional and physical problems, as well as a reduction in your capacity to operate at work and home (American Psychiatric Association, 2023).

The COVID-19 pandemic has significantly impacted people's physical and psychological well-being (Munawar & Choudhry, 2020). Most research found anxiety and depression symptoms among healthcare practitioners during COVID-19 (Zhu et al., 2020). For several reasons, it is necessary to explore the psychological impact of the current pandemic on field midwives (FMs). FMs’ optimal professional and social functioning requires good mental health. Even 1 year after the crisis, the psychological effects of a pandemic may persist among healthcare workers (HCWs; Lee et al., 2007). As a result, HCWs require adequate psychological treatment. The WHO has issued guidelines to healthcare authorities worldwide to ensure that HCWs have access to mental health treatments (WHO, 2020). However, to address this issue, it is necessary to evaluate the nature and extent of mental health issues among FMs in the local context.

Review of Literature

In the past, infectious diseases have had detrimental effects on people. More than 20 infectious agents, according to the WHO, were responsible for the emergence of multiple disease outbreaks. Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and H1N12 were three emerging infectious diseases that evolved at an unusually rapid pace and posed numerous difficulties to public health on a worldwide scale. SARS-CoV-2 droplets are the primary cause of COVID-19, which has a clinical spectrum of mild to moderate illness, severe, critical, and fatal conditions, and octogenarians with percentages of 80%, 15%, 5%, 0.5–2.8%, and 3.7–14.8%, respectively (Balkhair, 2020).

Numerous research studies have shown that healthcare personnel experienced high psychological distress during the COVID-19 outbreak. There is a considerable risk of psychological distress among FMs during COVID-19, especially since they are field health workers with their employment role. According to a Sri Lankan survey of 467 HCWs, the prevalence of depression, anxiety, and stress was 19.5%, 20.6%, and 11.8%, respectively. Being married, having children, living with family, and having a higher salary have all been associated with improved psychological outcomes. Poor mental health outcomes were predicted by beliefs about a lack of personal protective equipment, insufficient support from hospital authorities, increased prejudice, and insufficient training to interact with the situation (Baminiwatta et al., 2021).

The results of a study by Wu et al. (2009), involved 549 randomly chosen HCWs in Beijing, China in 2006 and examined the psychological impact of the SARS outbreak in 2003. This showed that after 3 years of an infectious disease outbreak, HCWs who had been quarantined, worked in SARS wards, or had friends or close relatives who had the disease had posttraumatic stress (PTS) symptoms. Additionally, it turns out that 10% of the participants had a severe case of PTS symptoms (Wu et al., 2009).

An online cross-sectional survey of healthcare professionals in India who are actively involved in the triage, screening, diagnosis, and treatment of COVID-19 patients, discovered that 11.4% and 17.7%, respectively, of patients had symptoms of depression that required treatment and anxiety that necessitated further investigation. It also declared that women who lived in a hostel or other temporary housing had a twofold increased chance of experiencing symptoms of anxiety or depression (Wilson et al., 2020).

Purpose of the Study

This study aimed to assess the level of anxiety, depression, and associated factors among FMs in selected Medical Officer of Health (MOH) areas in Matara District, Sri Lanka, during the COVID-19 Pandemic.

Methods

Design

A descriptive cross-sectional design was used. The data was collected from December 2021 to February 2022, after the peak spreading of the disease.

Sample, Inclusion/Exclusion Criteria

Nine MOH divisions in the Matara district were selected as study settings. The study population was comprised of FMs who were currently engaged in their occupation in the Matara district. FMs with 6 months of experience in their occupation and actively participating in their duties in selected MOH divisions in Matara district were included, and those on maternity leave were excluded. The sample size was calculated by using the Taro Yamane equation, and 0.05 was taken as the level of precision. The resulting sample size was 157. A final sample size of 165 was regarded as appropriate, given that possible non-responders. A list of MOH offices in Matara District was prepared alphabetically, and nine were selected by simple random sampling method. Again, the employee list randomly selected the predetermined number of participants from each nine MOH divisions.

The permission of the Regional Director of Health Services in Matara was obtained. The randomly selected participants were contacted individually by telephone to make an appointment for data collection since it was done during the COVID-19 pandemic. Data collection sessions were scheduled with the participants at mutually convenient times and locations. An information sheet was used to explain the study to the participants. Before administering the interviewer-administered questionnaire, participants provided written informed consent. All the data were collected by the principal investigator.

Study Instruments

Generalized anxiety disorder-7 (GAD-7; Institute for Research and Development, 2020) and Patient Health Questionnaire-9 (PHQ-9; Hanwella et al., 2014) are two validated questionnaires for assessing anxiety and depression, respectively. The Sinhala validated PHQ-9 demonstrated a sensitivity of 0.75, specificity of 0.97, and Cronbach's alpha of 0.90. Concurrent validity was assessed by correlating the total scores with the Centre for Epidemiological Studies Depression Scale reported Pearson correlation coefficient as 0.87 (Hanwella et al., 2014). The GAD-7 shows acceptable validity and reliability according to the results of the current study. The severity of anxiety was calculated by assigning scores of 0, 1, 2, and 3 to the response categories, respectively, of “not at all,” “several days,” “more than half the days,” and “nearly every day.” GAD-7 total score for the seven items ranges from 0 to 21. Severities are presented as follows: 0–4: minimal anxiety; 5–9: mild anxiety; 10–14: moderate anxiety; 15–21: severe anxiety. The PHQ-9 is the depression module, which scores each of the nine criteria as “0” (not at all) to “3” (nearly every day. The score will be assigned for several days = 1, more than half the days = 2, and nearly every day = 3. PHQ total score ranges from 0 to 27 and severities are presented as follows: 1–4: minimal depression; 5–9: mild depression; 10–14: moderate depression; 15–19: moderately severe depression; and 20–27: severe depression.

Together with the aforementioned instruments, a pre-tested sociodemographic questionnaire was administered. This sociodemographic questionnaire was prepared and refined by an expert team. The prior research was reviewed, and local sociocultural and administrative factors were taken into account when constructing this questionnaire. The panel reviewed and agreed on its content and face validity. Age, marital status, parental status, family type, place of residence (rural or urban), (home, quarters, temporary arrangement), years of experience, history of mental illnesses, history of chronic diseases, working in COVID-19 area, contact with suspected confirm COVID-19 cases, families, relatives or friends infected with COVID-19, and death of families, relatives or friends due to COVID-19. On average, the questionnaires took about 30 min to complete.

Statistical Analysis

Descriptive statistics were employed to summarize and present data on population characteristics. Prevalence rates were determined using GAD-7 and PHQ-9 cut-offs. The Chi-square test was used to identify components related to binary outcomes (e.g., depression, anxiety); significant factors were put into a logistic regression model. To describe the effect of social and occupational perceptions on GAD-7 outcomes, the 4-point Likert scale was recoded into a binary variable; the affirmative responses, that is, “mild anxiety,” “moderate anxiety,” and “severe anxiety,” were combined into one category, and the non-affirmative response, that is, “minimal anxiety,” remained in the other. Furthermore, the PHQ-9 outcomes, the 4-point Likert scale, were recoded into a binary variable; the affirmative responses, that is, “mild,” “moderate,” “moderately severe,” and “severe,” were combined into one category, while the non-affirmative response, that is, “none,” was preserved as one category. Logistic regression was used to investigate the factors associated with low anxiety and depression. Only variables with a p-value of less than 0.1 were considered in the multivariate analysis. In multivariate analysis, p values of less than 0.05 were considered statistically significant. Statistical Software Package for Social Sciences (SPSS) version 26.0 was used for data input and analysis.

Ethical Considerations

The study was approved by the Ethics Review Committee of the Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. Before data collection, participants were provided with comprehensive information regarding the nature, purpose, and procedures of the study. Informed consent was obtained from all participants, emphasizing voluntary participation, the right to withdraw at any stage without penalty, and assurances of confidentiality regarding their data. Strict measures were implemented to ensure the confidentiality and anonymity of participants. Any personal or identifying information collected during the study was kept strictly confidential, with data stored securely and accessible only to the research team.

Results

Sample Characteristics

Of 165 invited to participate, 145 returned completed questionnaires comprising an 87.8% response rate. Table 1 summarizes the sociodemographic characteristics of the participants. The mean age of the participants was 41.43 ± 12.01. The highest number of respondents was noted in the age group 20–34 years, 51(35.2). Participants who completed the survey were mostly married 119 (82.1%) and had one or more children 96 (66.2%) with a nuclear family. Most participants lived in home 131 (90.3%) and in rural areas 137 (94.5%). In the sample,142 (97.9%) were PHMs and 3 (2.1%) were SPHMs. Among the participants, most had experienced greater than 10 years 78 (53.8%) and 67 (46.2%) had 10 years or below. In addition, 27 (18.6%) of the participants stated that they have chronic diseases.

Table 1.

Sociodemographic Characteristics of Participants (n = 145).

Characteristics		Frequency	Percentage
Age	Mean ± sd (41.43 ± 12.01)20–3435–4950–65	515044	35.234.530.3
Marital status	SingleMarried	26119	17.982.1
Parental status	No childrenOne or more children	4996	33.866.2
Family type	NuclearExtended	9748	66.933.1
Place of residence	RuralUrban	1378	94.55.5
Accommodation	HomeQuartersTemporary arrangement	13177	90.34.84.8
Years of experience	10 years or belowGreater than 10 years	6778	46.253.8
History of mental disorders	YesNo	-100	-100
History of chronic diseases	YesNo	27118	18.681.4
Working in COVID-19 high area	YesNo	12124	83.416.6
Contact with suspected confirmed COVID-19 cases	YesNo	11926	82.117.9
Family members, relatives, or friends infected with COVID-19	YesNo	11035	75.924.1
Death of family members, relatives, or friends due to COVID-19	YesNo	12133	8.391.7
Personal protective equipment	SufficientInsufficient	31114	21.478.6
Economic status	HighModerateLow	-13015	-89.710.3

Prevalence of Anxiety

Table 2 summarizes the prevalence of GAD-7 outcomes in the total sample. The highest mean anxiety (0.88 ± 0.99) has been reported as “worrying too much about different things” and “feeling nervous, anxious, or on edge” (0.86 ± 0.87).

Table 2.

Prevalence of Anxiety as per the GAD-7 Scale (n = 145).

Over the last 2 weeks, how often have you been bothered by the following problems?	Mean(±SD)	Not at all	Several days	More than half the days	Nearly every day
1. Feeling nervous, anxious, or on edge	0.86 (0.87)	5336%	7350.3%	53.4%	149.7%
2. Not being able to stop or control worrying	0.74 (0.94)	7853.8%	3524.1%	2315.9%	96.2%
3. Worrying too much about different things	0.88 (0.99)	6242.8%	5739.3%	74.8%	1913.1%
4. Trouble relaxing	0.76 (0.86)	6846.9%	5235.9%	1711.7%	85.5%
5. Being so restless that it is hard to sit still	0.47 (0.73)	9756.9%	2920%	1812.4%	17%
6. Becoming easily annoyed or irritable	0.74 (0.95)	7652.4%	4329.7%	139%	139%
7. Feeling afraid, as if something awful might happen	0.42 (0.83)	10773.8%	2416.6%	53.4%	96.2%

Severity of Anxiety

Table 3 summarizes the severity of GAD-7 outcomes in the total sample. The majority of the sample reported to be having minimal anxiety (n = 79, 54.5%).

Table 3.

Severity of Anxiety as per the GAD-7 Scale (n = 145).

Severity	Frequency	Percentage (%)
Minimal anxiety	79	54.5
Mild anxiety	45	31.0
Moderate anxiety	12	8.3
Severe anxiety	9	6.2

Prevalence of Depression

According to Table 4, the highest mean score (1.25 ± 1.11) has been claimed to be “little interest or pleasure in doing things” and “feeling tired or having little energy” (1.06 ± 0.99) while least mean score (0.19 + 0.52) was “thoughts that you would be better off dead or hurting yourself in some way.”

Table 4.

Prevalence and Severity of Depression as per the PHQ-9 Scale (n = 145).

Over the last 2 weeks, how often have you been bothered by any of the following problems?	Mean(± SD)	Not at all	Several days	More than half the days	Nearly every day
1. Little interest or pleasure in doing things	1.25 (1.11)	4128.3%	6242.8%	74.8%	3524.1%
2. Feeling down, depressed, or hopeless	0.69 (0.84)	7451%	4933.8%	1510.3%	74.8%
3. Trouble falling or staying asleep, or sleeping too much	0.61 (0.88)	8558.6%	4128.3%	96.2%	106.9%
4. Feeling tired or having little energy	1.06 (0.99)	4732.4%	6242.8%	1611%	2013.8%
5. Poor appetite or overeating	0.52 (0.91)	9766.9%	3423.4%	00%	149.7%
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down	0.51 (0.82)	9666.2%	3020.7%	1320.7%	64.1%
7. Trouble concentrating on things, such as reading the newspaper or watching television	0.64 (0.91)	8558.6%	3725.5%	139%	106.9%
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual	0.28 (0.66)	11881.4%	1812.4%	53.4%	42.8%
9. Thoughts that you would be better off dead or hurting yourself in some way	0.19 (0.52)	12586.2%	1510.3%	32.1%	21.4%

Among the participants, 54.5%, 31.0%, 8.3%, and 6.2% experienced minimal, mild, moderate, and severe anxiety. Whereas 46.2%, 32.4%, 17.2%, 1.4%, and 2.8% of the participants had no or minimal, mild, moderate, moderately severe, and severe depression.

Severity of Depression

Table 5 summarizes the severity of PHQ-9 outcomes in the total sample. The majority of the sample reported to be having no depression (n = 67, 46.2%).

Table 5.

Severity of Depression as per the GAD-7 Scale (n = 145).

Severity	Frequency	Percentage (%)
None	67	46.2
Mild depression	47	32.4
Moderate depression	25	17.2
Moderately severe depression	2	1.4
Severe depression	4	2.8

Associated Factors for Anxiety and Depression

According to the bivariate analysis in Table 6, the type of family (p = 0.011), place of accommodation (p = 0.035), and whether or not there is a history of chronic disease (p = 0.001) all have a statistically significant association with minimal anxiety. Similarly, the type of family (p = 0.021) and whether or not there was a history of chronic disease (p = 0.001) had a statistically significant relationship with no depression. The factors with p < 0.1 significance were included in the multivariate analysis.

Table 6.

Sociodemographic Factors Associated with Depression and Anxiety (n = 145).

Demographic Characteristic	Depression					Anxiety
Demographic Characteristic	None or minimalN, (%)	Mild to severeN, (%)	Crude OR	95% CI	Chi-Square, p-value	None or minimalN, (%)	Mild to severeN, (%)	Crude OR	95% CI	Chi-Square,p-value
Age
More than 42	26 (17.9)	32 (22.0)	0.912	0.468–1.776	χ²= 0.074, P = 0.786	32 (22.0)	26 (17.9)	1.000	0.513–1.950	χ² = 0.000 p = 1.00
Less than 42	41 (28.2)	46 (31.7)	ref			48 (33.1)	39 (26.8)	ref
Marital status
Unmarried	12 (8.2)	14 (9.6)	0.997	0.426–2.336	χ²= 0.000P = 0.995	11 (7.5)	15 (10.3)	0.531	0.225–1.254	χ²= 2.120P = 0.145
Married	55 (37.9)	64 (44.1)	ref			69 (47.5)	50 (34.4)	ref
Parental status
No children	23 (15.8)	26 (17.9)	1.045	0.524–2.084	χ²= 0.016P = 0.900	24 (16.5)	25 (17.2)	0.686	0.343–1.369	χ²= 1.148P = 0.284
One or more children	44 (30.3)	52 (35.8)	ref			56 (38.6)	40 (27.5)	ref
Type of family
Nuclear	52 (35.8)	45 (31.3)	2.542	1.226–5.271	χ²= 6.458P = 0.011	60 (41.3)	37 (25.5)	2.270	1.122–4.595	χ²= 5.292P = 0.021
Extended	15 (10.3)	33 (22.7)	ref			20 (13.7)	28 (19.3)	ref
Accommodation
Home	62 (42.7)	69 (47.5)	1.617	0.514–5.086	χ²= 0.686P = 0.407	76 (52.4)	55 (37.9)	3.455	1.030–11.589	χ²= 4.434P = 0.035
Quarters or temporary arrangement	5 (3.4)	9 (6.2)	ref			4 (2.7)	10 (6.8)	ref
Years of experience
10 years and below	30 (20.6)	37 (25.5)	0.898	0.467–1.730	χ²= 0.103P = 0.749	36 (24.8)	31 (21.3)	0.897	0.456–1.730	χ²= 0.105P = 0.746
More than 10 years	37 (25.5)	41 (28.2)	ref			44 (30.3)	34 (23.4)	ref
Any history of chronic disease
Yes	5 (3.4)	22 (15.1)	0.205	0.073–0.579	χ²= 10.233P = 0.001	6 (4.1)	21 (14.4)	0.170	0.064–0.453	χ²= 14.565P < 0.001
No	62 (42.7)	56 (38.6)	ref			74 (51.0)	44 (30.3)	ref
Working in COVID-19 high area
Yes	59 (40.6)	62 (42.7)	1.903	0.758–4.778	χ²= 1.918P = 0.166	71 (48.9)	50 (34.4)	2.367	0.960–5.834	χ²= 3.632P = 0.057
No	8 (5.5)	16 (11.0)	ref			09 (6.2)	15 (10.3)	ref
Contact with suspected confirmed COVID-19 cases
Yes	55 (37.9)	64 (44.1)	1.003	0.428–2.318	χ²= 0.000P = 0.995	64 (44.1)	55 (37.9)	0.727	0.305–1.733	χ²= 0.519P = 0.471
No	12 (8.2)	14 (9.6)	ref			16	10	ref
Family members, relatives, or friends infected with COVID-19
Yes	46 (31.7)	64 (44.1)	0.479	0.221–1.040	χ²= 3.531P = 0.060	58 (40.0)	52 (35.8)	0.659	0.302–1.439	χ²= 1.102P = 0.294
No	21 (14.4)	14 (9.6)	ref			22 (15.1)	13 (8.9)	ref
Death of family members, relatives, or friends due to COVID-19
Yes	6 (4.1)	6 (4.1)	1.180	0.362–3.848	χ²= 0.076P = 0.783	4 (2.7)	8 (5.5)	0.375	0.108–1.307	χ²= 2.523P = 0.112
No	61 (42.0)	72 (49.6)	ref			76 (52.4)	57 (39.3)	ref
Personal protective equipment
Sufficient	10 (6.8)	21 (14.4)	0.476	0.206–1.101	χ²= 3.087P = 0.079	18 (12.4)	13 (8.9)	1.161	0.520–2.592	χ²= 0.133P = 0.715
insufficient	57 (39.3)	57 (39.3)	ref			62 (42.7)	52 (35.8)	ref
Economic status
Moderate to high	61 (42.0)	69 (47.5)	1.326	0.446–3.940	χ²= 0.259P = 0.611	74 (51.0)	56 (38.6)	1.982	0.667–5.894	χ²= 1.557P = 0.212
Low	6 (4.1)	9 (6.2)	ref			6 (4.1)	9 (6.2)	ref

Note. ref = reference category; OR = odds ratio.

Table 7 shows the relationships between socio-demographic characteristics and depression and anxiety. Being in a family of COVID-19-infected family members, relatives, or friends (OR = 0.33, p = 0.018) and being in a nuclear family (OR = 0.47, p = 0.033) were found to be risk factors against depression while having a history of chronic diseases (OR = 5.87, p = 0.002) and having a sufficient amount of PPEs (OR = 2.52, p = 0.041) were found to be protective. Similarly, having a history of chronic diseases (OR = 4.89, p = 0.002) was found to be protective against anxiety.

Table 7.

Factors Associated with Depression and Anxiety, After Adjusting for Sociodemographic Factors Using Binary Logistic Regression (n = 145).

Demographic characteristic	Depression			Anxiety
Demographic characteristic	Adjusted OR	95% CI	p-value	Adjusted OR	95% CI	p-value
Being in a nuclear family	0.417	0.187–0.931	0.033	0.518	0.241–1.112	0.091
Having a history of chronic diseases	5.870	1.931–17.839	0.002	4.894	1.776–13.484	0.002
Sufficient amount of personal protective equipment	2.525	1.039–6.135	0.041
Family members, relatives, or friends infected with COVID-19	0.333	0.133–0.830	0.018
Accommodation in home				2.871	0.738–11.170	0.128
Working in COVID-19 high area				1.659	0.585–4.01	0.341

Note. AOR = Adjusted odds ratio; only the sociodemographic variables that were found to be p < 0.1 were included in the logistic regression model as covariates.

Significant at 95% confidence.

Discussion

For the first time, the study reported on the level of anxiety and depression among 145 FMs across nine MOH regions in Matara District during the COVID-19 pandemic. The majority of individuals (55%) reported minimal anxiety and no (46%) or mild (32%) depression. The category of “FMs” exists in only a few countries, and there is no literature to compare the results of a similar study. As a result, the authors compare the findings to “health care workers,” despite differences in occupational roles.

All HCWs have a higher prevalence of psychological morbidity than the general Sri Lankan population. A prior study of non-HCWs in the country found that depression and anxiety disorders were prevalent in 6.6% and 9.1% of the population, respectively (Dorrington et al., 2014). These prevalence rates among Sri Lankan HCWs appear to be at the lower end of the range of other countries’ findings. A review of studies on HCWs’ mental health during the pandemic found a prevalence of depression of 20–40% and anxiety of 30–70% in various other countries (Braquehais et al., 2020).

In contrast to the current study, a study examined how anxious, and depressed HCWs were in Egypt during the COVID-19 breakout, and it found that approximately 9.5% did not have generalized anxiety, while the remaining 90.5% reported varying degrees of anxiety, with mild anxiety affecting about 40% of participants, moderate anxiety affecting 32%, and severe anxiety affecting 18.5% (Aly et al., 2021). The Egyptian study was undertaken during the acute period of COVID-19 or at the peak of COVID-19, whereas the current study was conducted later in the COVID-19 pandemic. Thus there is a possibility to increase the percentage of having minimal anxiety in FMs in the present study.

This cross-sectional study found that 2.8% of FMs were severely depressive, whereas an Iran study found that 6.8% of nurses were severely depressed. While in the present study 46.2%, 32.4%, 17.2%, and 1.4% showed none, mild, moderate, and moderately severe depression. The study was done in Iran and showed none (29.0%), mild (33.6%), moderate (20.0%), and moderately severe anxiety (10.7%) (Pouralizadeh et al., 2020). A previous study done in India showed about half (54.02%) of the HCWs had depression; 30.75% had mild; 12.93% had moderate; and 10.34% had severe depression (Singh et al., 2021) and when contrasted with the present study, the majority of FMs showed none or minimal and mild depression with COVID-19. This may happen if the FMs practice the best coping styles.

According to this study, being in a nuclear family raises the chance of depression. People in the extended family in Sri Lankan society typically receive a lot of familial support networks from one another. A Chinese cohort responded that the most important coping mechanism was seeking assistance from family and friends (Cai et al., 2020). Those who were required to live apart from their families had a higher incidence of psychological issues. It was discovered that coping with the help of family and acquaintances protects against mental health disorders. Being accommodated at home was protective against anxiety in this study, but it was not significant in multivariate analysis. Further infecting family members, relatives, or friends with COVID-19 was found to be a strong predictor of mental health disorders in earlier studies (Braquehais et al., 2020; Lai et al., 2020). These findings highlight the impact of family-related issues on the mental health of HCWs during a pandemic.

Furthermore, our study discovered that those who have an adequate number of PPEs are protected from depression. According to research, a perceived lack of PPE increases the risk of mental health disturbance (Braquehais et al., 2020; Dai et al., 2020). This emphasizes the importance of making PPE available to healthcare professionals.

The current study found that people who have a history of chronic disease are less likely to suffer from anxiety and depression. Yet, 81% of the participants in our group have no history of chronic conditions. In contrast, a prior study found that having chronic conditions increases the likelihood of having depressed symptoms by 112% (Pouralizadeh et al., 2020).

Strengths and Limitations

The high response rate of approximately 88%, which can be attributed to convenience sampling and the various strategies employed by the researchers to ensure a satisfactory response rate, is a strength of this study. Because the geographical distribution of COVID-19 varied, it is impossible to generalize the study's findings. These context-specific challenges are a limitation because this sample was drawn from a single district. Although anxiety and depression were assessed using a validated instrument, the sociodemographic questionnaire, which assessed social and occupational situations, was not a completely validated instrument, which may limit the validity of some conclusions drawn from responses to this questionnaire.

Implications for Practice

These results imply that FMs may have some resilience or coping strategies that have contributed to their relatively lower levels of depression and anxiety. Organizations may think about researching these elements and including them in employee wellness initiatives. This might consist of advocating methods for managing anxiety and depression, offering strategies for developing resilience, and supporting a healthy work-life balance.

Finding the techniques or practices that helped the FMs have lower levels of anxiety and depression may result in the development of best practices that can be disseminated to other workers and businesses. Organizations might host webinars, workshops, or knowledge-sharing events to propagate these strategies and encourage mental health.

To comprehend the specific factors that contributed to FMs’ well-being during the pandemic, further research can be done. Studies conducted in collaboration with specialists in the field of mental health, psychologists, and facility managers can offer deeper insights and direct the development of evidence-based approaches.

Further, the findings may contribute to a better understanding of mental health issues among midwives in various countries and regions. This information can be used to uncover common characteristics and patterns, resulting in more effective interventions and support systems around the world.

Conclusions

The majority of FMs had minimal anxiety and depression during the COVID-19 pandemic. Being in a family of COVID-19-infected family members, relatives, or friends and being in a nuclear family were found to be risk factors against depression while having a history of chronic diseases and having a sufficient amount of personal protective equipment were found to be protective. Similarly, having a history of chronic diseases was found to be protective against anxiety.

Footnotes

Acknowledgments

The authors, with great respect, appreciate the cooperation extended by the administrative officials of respective MOH divisions and all the study participants.

Authors’ Contribution

JMP and AATD contributed to the conceptualization and design of the study. All the authors contributed to data analysis and interpretation. NPE drafted the article. All authors have read and approved the final manuscript and each author believes that the manuscript represents honest work.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Considerations

Ethical approval was granted for this study by the Ethics Review Committee (ERC), Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka (Nur/09/21).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

NP Edirisinghe

References

Aly

H. M.

Nemr

N. A.

Kishk

R. M.

Elsaid

N. M. A. B.

(2021). Stress, anxiety, and depression among healthcare workers facing COVID-19 pandemic in Egypt: A cross-sectional online-based study. BMJ Open, 11(4), e045281. https://doi.org/10.1136/bmjopen-2020-045281

American Psychiatric Association (2023). What is depression. Retrieved February 11, 2023, from https://www.psychiatry.org/patients-families/depression/what-is-depression.

American Psychological Association (2023). Anxiety. Retrieved February 11, 2023, from https://www.apa.org/topics/anxiety.

Balkhair

A. A.

(2020). COVID-19 pandemic: A new chapter in the history of infectious diseases. Oman Medical Journal, 35(2), e123. https://doi.org/10.5001/omj.2020.41

Baminiwatta

De Silva

Hapangama

Basnayake

Abayaweera

Kulasinghe

Kaushalya

Williams

(2021). Impact of COVID-19 on the mental health of frontline and non-frontline healthcare workers in Sri Lanka. Ceylon Medical Journal, 66(1), 16. https://doi.org/10.4038/cmj.v66i1.9351

Braquehais

M. D.

Vargas-Cáceres

Gómez-Durán

Nieva

Valero

Casas

Bruguera

(2020). The impact of the COVID-19 pandemic on the mental health of healthcare professionals. QJM, hcaa207. https://doi.org/10.1093/qjmed/hcaa207

Cai

Chen

Jiang

Zhuang

(2020). Psychological impact and coping strategies of frontline medical staff in hunan between January and march 2020 during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, e924171. https://doi.org/10.12659/MSM.924171

Dai

Xiong

Qiu

Yuan

(2020). Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. medRxiv. https://doi.org/10.1101/2020.03.03.20030874

Dorrington

Zavos

Ball

McGuffin

Rijsdijk

Siribaddana

Sumathipala

Hotopf

(2014). Trauma, post-traumatic stress disorder and psychiatric disorders in a middle-income setting: Prevalence and comorbidity. The British Journal of Psychiatry : The Journal of Mental Science, 205(5), 383–389. https://doi.org/10.1192/bjp.bp.113.141796

10.

Hanwella

Ekanayake

de Silva

V. A.

(2014). The validity and reliability of the sinhala translation of the patient health questionnaire (PHQ-9) and PHQ-2 screener. Depression Research and Treatment, 2014, 768978. https://doi.org/10.1155/2014/768978

11.

Institute for Research and Development in Health & Social Care, Instruments Adapted & Validated for use in Sri Lanka (2020). Retrieved May 2, 2023, from https://www.ird.lk/research/research-instruments/#adult-assessments.

12.

Lai

Wang

Cai

Wei

Chen

Tan

Kang

Yao

Huang

Wang

Liu

(2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network Open, 3(3), e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976

13.

Lee

A. M.

Wong

J. G.

McAlonan

G. M.

Cheung

Sham

P. C.

Chu

C. M.

Wong

P. C.

Tsang

K. W.

Chua

S. E.

(2007). Stress and psychological distress among SARS survivors 1 year after the outbreak. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 52(4), 233–240. https://doi.org/10.1177/070674370705200405

14.

Munawar

Choudhry

F. R.

(2020). Exploring stress coping strategies of frontline emergency health workers dealing COVID-19 in Pakistan: A Qualitative Inquiry. American Journal of Infection Control, 49(3). https://doi.org/10.1016/j.ajic.2020.06.214

15.

Pouralizadeh

Bostani

Maroufizadeh

Ghanbari

Khoshbakht

Alavi

S. A.

Ashrafi

(2020). Anxiety and depression and the related factors in nurses of Guilan University of Medical Sciences hospitals during COVID-19: A web-based cross-sectional study. International Journal of Africa Nursing Sciences, 13, 100233. https://doi.org/10.1016/j.ijans.2020.100233

16.

Singh

Sood

Chadda

R. K.

Singh

Kattula

(2021). Mental health issues and coping among health care workers during COVID19 pandemic: Indian perspective. Asian Journal of Psychiatry, 61, 102685. https://doi.org/10.1016/j.ajp.2021.10268

17.

Wilson

Raj

J. P.

Rao

Ghiya

Nedungalaparambil

N. M.

Mundra

Mathew

(2020). Prevalence and predictors of stress, anxiety, and depression among healthcare workers managing COVID-19 pandemic in India: A nationwide observational study. Indian Journal of Psychological Medicine, 025371762093399. https://doi.org/10.1177/0253717620933992

18.

World Health Organization. (2020). Mental health and psychosocial considerations during the COVID-19 outbreak. World Health Organization. Retrieved May 2, 2023, from https://www.who.int/ publications-detail/WHO-2019-nCoV-MentalHealth-2020. 1.

19.

Fang

Guan

Fan

Kong

Yao

Liu

Fuller

C. J.

Susser

Hoven

C. W.

(2009). The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. The Canadian Journal of Psychiatry, 54(5), 302–311. https://doi.org/10.1177/070674370905400504

20.

Zhu

Wang

Liu

Miao

Zhang

Yang

Sun

Zhu

Fan

Chen

Liu

Wang

(2020). COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinicalMedicine, 24, 100443. https://doi.org/10.1016/j.eclinm.2020.100443

Anxiety,Depression,and Associated Factors Among the Field Midwives During COVID-19 Pandemic in Sri Lanka—A Descriptive Cross-Sectional Study

Abstract

Introduction

Objective

Methods

Results

Conclusion

Keywords

Introduction/Background

Review of Literature

Purpose of the Study

Methods

Design

Sample, Inclusion/Exclusion Criteria

Study Instruments

Statistical Analysis

Ethical Considerations

Results

Sample Characteristics

Prevalence of Anxiety

Severity of Anxiety

Prevalence of Depression

Severity of Depression

Associated Factors for Anxiety and Depression

Discussion

Strengths and Limitations

Implications for Practice

Conclusions

Footnotes

Acknowledgments

Authors’ Contribution

Declaration of Conflicting Interests

Ethical Considerations

Funding

ORCID iD

References