|Year : 2021 | Volume
| Issue : 2 | Page : 148-153
Anxiety among otolaryngology residents during the Coronavirus Disease of 2019 pandemic in Saudi Arabia: A descriptive cross-sectional study
Hessah Saad Alsayahi1, Abdulaziz Yousef Alturki1, Nouf Mohammed Almansour1, Zuhour Abdullah Alqahtani1, Hatim Ibrahim Alassaf1, Arwa Mohammad Alabdulsalam1, Aseel Abdulkarim Alfahhad1, Roba Mohsin Altameem1, Fahad Z Alotaibi2
1 Medical intern, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
2 Assistant Professor and Consultant of Otolaryngology, Head and Neck surgery at Al Imam Muhammad Ibn Saud Islamic University ( IMSIU ) Riyadh, Saudi Arabia
|Date of Submission||22-Jul-2020|
|Date of Decision||23-Aug-2020|
|Date of Acceptance||19-Sep-2020|
|Date of Web Publication||13-Apr-2021|
Abdulaziz Yousef Alturki
Medical College, Imam Muhammad Ibn Saud Islamic University, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Otolaryngologists are among the health professionals most commonly working on the front lines against coronavirus disease of 2019 (COVID-19). They are at high risk of exposure, as well as physical and psychological stress. Nevertheless, the psychological influence of working during the pandemic still needs to be explored. Objective: This study aims to assess the anxiety symptoms among otolaryngology residents in Saudi Arabia during the novel coronavirus (COVID-19) pandemic. Materials and Methods: A cross-sectional qualitative study was carried out via a survey sent to otolaryngology residents in Saudi Arabia. The questionnaire collected demographic data and included questions using the 7-item Generalized Anxiety Disorder (GAD-7) scale to evaluate the residents' anxiety toward working during the pandemic. Data analysis was conducted using R v 3.6.2. Results: Ninety-three otolaryngology residents completed the online questionnaire with a response rate of 42.5%. Of them, 30.1% had been in contact with confirmed COVID-19 patients. More than two-thirds of the respondents (68.8%) suffered from anxiety based on the GAD-7 scale; in the results, 45.2% had mild anxiety, 12.9% had moderate anxiety, and 10.8% had severe anxiety. Almost 24% of the respondents suffered from anxiety with a score of 10 or greater on the GAD-7 used as a cutoff point. Anxiety was more prevalent in married residents compared with single ones (18.9% vs. 5.45%, P = 0.002). In addition, it was prevalent in 40% of smokers compared with 5.13% of nonsmokers (P = 0.001). Conclusion: Anxiety levels among otolaryngology residents were high during the COVID-19 pandemic.
Keywords: Anxiety, coronavirus disease of 2019, otolaryngology residents, Saudi Arabia
|How to cite this article:|
Alsayahi HS, Alturki AY, Almansour NM, Alqahtani ZA, Alassaf HI, Alabdulsalam AM, Alfahhad AA, Altameem RM, Alotaibi FZ. Anxiety among otolaryngology residents during the Coronavirus Disease of 2019 pandemic in Saudi Arabia: A descriptive cross-sectional study. J Nat Sci Med 2021;4:148-53
|How to cite this URL:|
Alsayahi HS, Alturki AY, Almansour NM, Alqahtani ZA, Alassaf HI, Alabdulsalam AM, Alfahhad AA, Altameem RM, Alotaibi FZ. Anxiety among otolaryngology residents during the Coronavirus Disease of 2019 pandemic in Saudi Arabia: A descriptive cross-sectional study. J Nat Sci Med [serial online] 2021 [cited 2021 May 16];4:148-53. Available from: https://www.jnsmonline.org/text.asp?2021/4/2/148/313650
| Introduction|| |
The coronavirus disease of 2019 (COVID-19) pandemic represents a significant challenge for health-care providers. While all health-care providers have some exposure risk, personnel in specific medical specialties are at an increased risk, especially those caring for patients undergoing mucosal- or aerosol-generating procedures.,, Previous studies from China report higher rates of COVID-19 infection among otolaryngologists, likely due to the nature of their practice, examination techniques, and use of high-risk aerosol-generating procedures in their usual routine daily practice.,,,
Although the use of personal protective equipment is considered the standard of practice in managing patients in this era, this essential resource is already becoming rare, and the shortage of resources is another rising problem. In addition, physicians are being faced with increasing numbers of infected cases, unfamiliar hospital roles, and concern for their safety, as well as the safety of their loved ones and their patients. Thus, beyond their physical health, there is also a great risk to their mental well-being.
According to previous studies, during outbreaks of severe acute respiratory syndrome on 2003 and Middle East respiratory syndrome on 2012, frontline medical staff reported high levels of stress that resulted in posttraumatic stress disorder. It was also found that health-care workers considered resignation, faced stigmatization, and feared contagion and spread to family and friends, resulting in high levels of stress, depression, and anxiety symptoms.,
Studies from COVID-19 in China, where it was first detected, as well as in other Asian countries, have already shown increased mental stress on health-care workers, reflected through using validated surveys on anxiety, depression, and distress. This evidence suggests a need to provide early psychological support and intervention to prevent any immediate or delayed consequences that may affect their health or patient care.,
Despite the literature evidence of increased anxiety symptoms in health-care workers during outbreaks, few studies have looked specifically at the level of anxiety among otolaryngologists. This study aims to assess anxiety symptoms among otolaryngology residents in Saudi Arabia during the COVID-19 pandemic by measuring symptoms of anxiety using the 7-item Generalized Anxiety Disorder (GAD-7) scale.
| Materials and Methods|| |
Study design and setting
This study is a cross-sectional qualitative study. It was conducted in central, eastern, southern and western regions of Saudi Arabia, from 7th to 12th of June 2020, which was a peak period of the pandemic in the kingdom of Saudi Arabia.
All otolaryngology residents registered in the residency training program from postgraduate year (PGY1 to PGY5) were invited to participate. According to the Saudi Commission for Health Specialties, there were 219 otolaryngology residents as of 2019. The Raosoft calculator was used to calculate the sample size with a 10% margin of error and a 95% confidence interval. Based on the results, the minimum sample size required for this study was 67, and 93 otolaryngology residents from different regions in Saudi Arabia ultimately participated.
Data collection and management
An anonymous online questionnaire was used to assess the anxiety levels among otolaryngology residents during the COVID-19 pandemic. Up to two reminders were sent to the residents by E-mail and phone. The questionnaire included questions about demographic information (gender, marital status, region, and place of residence). The GAD-7 scale (range, 0–21) was used to assess symptoms of anxiety over the past 2 weeks, with a scale of normal (0–4), mild (5–9), moderate (10–14), and severe (15–21) anxiety. Cronbach's alpha was employed to assess the reliability of the GAD-7 scale. A value >0.7 indicated good internal consistency.
Statistical analysis was performed using R version 3.6.2. Counts and percentages were used to summarize categorical variables. A univariate analysis (nonparametric test using a Chi-square test of independence) was employed to assess the association between demographic characteristics of the included residents and the anxiety level during the COVID-19 epidemic. A Chi-square test of independence was also used to evaluate the association between COVID-19-related stressors, including family and daily life-related stressors, as well as stressors related to delays in academic activities and anxiety level. P < 0.05 was considered statistically significant.
The Institutional Review Board approval was obtained from the Research Ethical Committee, College of Medicine (IMSIU). Participation was optional, the research purpose was explained, and informed consent was obtained.
| Results|| |
Ninety-three otolaryngology residents completed the online questionnaire with a response rate of 42.5%. Only participants who fit the inclusion criteria were included. The sociodemographics of participants and analysis of the questionnaire are shown in [Table 1].
Anxiety levels in the study sample
The results showed that 40.9% of the residents had been restless for at least several days of the week, finding it hard to sit still. Half of the participants (47.3%) had worried too much about different things on several days over the past 2 weeks, and 45.2% had had trouble relaxing on several days over the past 2 weeks. The remaining 10.8% and 16.1% had had trouble relaxing more than half of the days and every day, respectively. In addition, about half of the residents (51.6%) had felt nervous or anxious several days over the past 2 weeks. Results that included “more than half the days” and “nearly every day” did not exceed 30% for any of the seven questions, as shown in [Figure 1].
|Figure 1: Responses to the Generalized Anxiety Disorder-7 individual questions|
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The results showed that anxiety was more prevalent in married residents compared with single ones (18.9% vs. 5.45%, P < 0.05). Anxiety was present in 40% of smokers compared with 5.13% of nonsmokers. Interestingly, anxiety was more prevalent in individuals who did not have contact with confirmed COVID-19 cases (15.4%) compared with those who had contact (0%), and the difference was statistically significant (P < 0.05).[Table 2]
|Table 2: Association between characteristics of the residents and anxiety level|
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Correlation between COVID-19 stressors and anxiety levels:
Turning to COVID-19 stressors and anxiety levels, concerns related to the impact of COVID-19 on daily life were associated with higher anxiety (P =0.048). Awareness regarding guidelines related to otolaryngology practice and procedures during the pandemic was associated with lower anxiety levels (P =0.016) as shown in [Table 4].
|Table 4: Correlation between otolaryngology residents and anxiety levels|
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Anxiety related to coronavirus disease of 2019
The residents were asked a set of questions to evaluate their concerns about COVID-19 [Table 3].
Almost 24% of the respondents suffered from anxiety with a score of 10 or greater on the GAD-7 used as a cutoff point, as described in [Figure 2].
|Figure 2: Distribution of the overall 7-item Generalized Anxiety Disorder scale scores|
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The results showed that concerns related to the effects of COVID-19 on daily life were associated with higher anxiety (P < 0.05). Awareness regarding guidelines related to otolaryngology practice and procedures during the pandemic was associated with lower anxiety levels (P < 0.05). [Table 5]
| Discussion|| |
In this national-based survey performed in Saudi Arabia, we found that anxiety symptoms were prevalent among the participants. A score of 10 or greater on the GAD-7 was used as a cutoff point for identifying cases of GAD, and 23.7% of our participants scored above the cutoff; when compared with to Civantos et al.'s findings for a sample of American otolaryngologists, where the anxiety rate was 18.9% based on GAD-7, Saudi residents had a higher prevalence.
A higher GAD-7 score, reflecting more severe anxiety, was more common in married (18.9%, P = 0.002) compared with the other groups, supporting the suggestion that having family and other people to take care of is considered a significant source of anxiety. We also found that smokers tend to have a statistically significant higher GAD-7 score (40%, P = 0.001) which can be attributed to the fact that smoking is a risk factor for having more severe disease and higher rate of mortality compared to people who do not smoke. Although female physicians were at a higher risk of anxiety and other psychological symptoms, as shown in other studies, the current study did not find any significant difference in anxiety levels between male and female residents.
Residents familiar with the newly adopted hospital policies during the pandemic tended to have lower anxiety levels, reflecting the importance of having access to up-to-date information and educational materials required to prepare them well. According to Civantos et al., a higher number of positive cases in one region compared with another is associated with more physical and mental stress on otolaryngology residents. We found no difference in anxiety symptoms between residents working in areas with a high volume of COVID-19 cases (e.g., the western region) compared with other regions of Saudi Arabia.
Clinical education and surgical training are affected by the disruption of routine health-care delivery, such as elective surgeries, teaching activities, and the deployment of residents to COVID-19-related services. This has resulted in a significant reduction in surgical and clinical exposure, which could affect the residents' competency later. More than 80% of the residents were concerned about academic performance and lack of communication with program directors about alternative ways to compensate for the disruption. Although this pandemic has severely compromised residency training in almost all specialties, the program director has to work closely with residents to deal with the shortage using alternative educational methods, such as video teleconferencing, virtual lectures, virtual ground rounds, podcasts, and virtual reality platforms, which have proven to be useful in the literature.,
Our study had several limitations. One is that it measured a short-term effect of the pandemic, but the long-term consequences need further investigation. In addition, the sample size was relatively small. Given our response rates, we cannot exclude the possibility of nonresponse bias.
| Conclusion|| |
The COVID-19 pandemic presents a major challenge to otolaryngologists under training; this is due not only to the risk of infection but also the associated higher level of anxiety, as observed in our study. Protective measures should be taken to provide residents with adequate psychological support, and smart electronic learning strategies should be adopted to ensure the continuity of training.
The authors thank all the residents for their participation. We are also grateful to Dr. Feras Alkholaiwi, Dr. Abullah Alanazi, and Dr. Abdullah Alqahtani for their assistance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]