BİRİNCİ BASAMAK SAĞLIK ÇALIŞANLARININ COVID-19 DÖNEMİNDEKİ RUH SAĞLIĞI: KESİTSEL BİR ÇALIŞMA

Abstract

Amaç: COVID-19 pandemisinde önemli görevler üstlenen birinci basamak çalışanlarında artan iş yükü, enfekte olma ve hastalığı yayma korkusu, hastalık hakkındaki belirsizlikler gibi nedenler ciddi psikolojik yük oluşturmuştur. Bu çalışmadaki amaç; toplumda derin izler bırakan pandeminin birinci basamak sağlık çalışanlarında yarattığı stres, anksiyete ve depresyon düzeylerini, baş etme stillerini belirleyip ilişkili faktörleri incelemektir. Metot: Temmuz ve Eylül 2020 tarihleri arasında 316 aile hekimi ve aile sağlığı elemanına (ASE) sosyodemografik özellikler ve pandemi döneminde yaşanabilecek sorunlara dair sorular ile Hastane Anksiyete Depresyon Ölçeği (HADÖ), Başa Çıkma Stilleri Ölçeği Kısa Formu (BÇSÖ-KF) ve Olayların Etkisi Ölçeği Revize Formundan (OEÖ-R) oluşan bir online anket uygulanmıştır. Bulgular: Sağlık çalışanlarının %59,5’i (n=188) hekim, %49,7’si (n=157) kadın, meslekteki hizmet yılları 11,6±7,5 idi. Travmatik stres, anksiyete ve depresif belirti sıklığı sırasıyla %55,7 (n=176), %40,8 (n=129) ve %71,8 (n=227) idi. Travmatik stresin kadınlarda (p=0,001), evinde kronik hasta olanlarda (p=0,011), kişisel koruyucu ekipmana (KKE) kolay ulaşamadığını belirtenlerde (p<0,001), çalışırken kendini COVID-19 açısından güvende hissetmeyenlerde (p=0,007) daha yüksek olduğu tespit edilmiştir. ASE’lerin anksiyete düzeyleri daha yüksek bulunmuştur (p=0,001). Hem anksiyete hem de depresyon seviyeleri anlamlı düzeyde yüksek bulunanlarsa kadınlar (sırasıyla p<0,001 ve p=0,006), evinde kronik hasta olanlar (sırasıyla p=0,001 ve p=0,004), KKE’ye kolay ulaşamadığını belirtenler (sırasıyla p<0,001 ve p=0,002), çalışırken kendini COVID-19 açısından güvende hissetmeyenler (her iki p<0,001) idi. Hem adaptif hem de maladaptif başa çıkma stillerini kadınların (sırasıyla p<0,001 ve p=0,042); adaptif stilleri evlilerin ve ASE’lerin daha fazla kullandıkları saptanmıştır (sırasıyla p=0,030 ve p=0,032). Hekimlerde travmatik stresin ASE’lere oranla %68 daha az görüldüğü (OR: 0,32 [%95 GA: 0,15-0,71], p=0,018); belirlenmiştir. Stres varlığının hem anksiyete (OR: 2,74 [%95 GA: 1,38-5,45], p=0,004) hem de depresyon (OR: 2,11 [%95 GA: 1,03-4,32], p=0,042) için risk faktörü olduğu saptanmıştır. Sonuç: Birinci basamak çalışanlarının pandemi etkileri açısından düzenli izlenmesi ve sağlık çalışanlarına duygusal, ruhsal ve sosyal destek vermek için uygun programların hayata geçirilmesi pandemilerde birincil öncelik olmalıdır.

Keywords

• COVID-19 pandemisi
• birinci basamak çalışanları
• travmatik stres
• anksiyete
• depresyon
• başa çıkma stilleri

Supporting Institution

Bu çalışma herhangi bir kurum veya kuruluştan finansman almamıştır.

Ethical Statement

Çalışma için etik kurul onayı Diyarbakır için Dicle Üniversitesi Tıp Fakültesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan (Tarih: 04.06.2020, No: 200) Batman için Selçuk Üniversitesi Yerel Etik Kurulu’ndan (Tarih: 03.06.2020 ve 2020/222 Karar No) alınmıştır. Çalışma COVID-19 ile ilgili olduğu için gerekli diğer izinler (Bakanlık izni gibi) de alınmıştır. Araştırma, “Aydınlatılmış Onam, Gizlilik ve Gizliliğin Korunması ve Özerklik Saygı” etik ilkelerine ve Helsinki Bildirgesine uygun yapılmıştır.

Thanks

Bütün birinci basamak sağlık çalışanlarının pandemideki özverili çalışmalarını takdirle karşılıyor, araştırmamıza katılanlara teşekkür ediyoruz.

MENTAL HEALTH OF PRIMARY CARE WORKERS DURING COVID-19 PANDEMIC: A CROSS-SECTIONAL STUDY

Abstract

Objective: Increased workload, fear of becoming infected and spreading the virus, and uncertainties about the disease have created a serious psychological burden on primary care workers who undertake important tasks in the COVID-19 pandemic. The aim of this study was to determine the stress, anxiety and depression levels, coping styles and related factors caused by the pandemic, which left deep traces in the society, in primary health care workers. Method: Between July and September 2020, an online questionnaire consisting of questions about sociodemographic characteristics and problems that may be experienced during the pandemic period, and the Hospital Anxiety Depression Scale (HADS), Coping Styles Scale Brief Form (Brief-COPE) and Impact of Events Scale Revised Form (IES-R) were administered to 316 family physicians and family health workers (FHWs). Results: Of the healthcare workers, 59.5% (n=188) were physicians, 49.7% (n=157) were women, and their professional experience were 11.6±7.5 years. The frequency of traumatic stress, anxiety and depressive symptoms were 55.7% (n=176), 40.8% (n=129) and 71.8% (n=227), respectively. Traumatic stress was found to be higher in women (p=0.001), in those who had chronic patients at home (p=0.011), in those who stated that they could not easily reach the personal protective equipment (PPE) (p<0.001), and in those who did not feel safe themselves in terms of COVID-19 while working (p=0.007). Anxiety levels of FHWs were found to be higher (p=0.001). Those with significantly higher levels of both anxiety and depression were women (p<0.001 and p=0.006, respectively), those with chronic patients at home (p=0.001 and p=0.004, respectively), those who stated that they could not easily access PPE (p<0.001 and p=0.002, respectively), and those who did not feel safe themselves in terms of COVID-19 while working (both p<0.001). It was found that both adaptive and maladaptive coping styles were used more by women (p<0.001 and p=0.042, respectively) and adaptive styles were used more by those who were married and by FHWs (p=0.030 and p=0.032, respectively). It was determined that traumatic stress was 68% less common in physicians compared to FHWs (OR: 0.32 [95% CI: 0.15-0.71], p=0.018). The presence of stress was found to be a risk factor for both anxiety (OR: 2.74 [95% CI: 1.38-5.45], p=0.004) and depression (OR: 2.11 [95% CI: 1.03-4.32], p=0.042). Conclusion: Regular monitoring to assess the effects of the pandemic on primary care workers and implementing appropriate programmes to provide emotional, psychological and social support to healthcare workers should be a top priority during the pandemics.

Keywords

• COVID-19 pandemic
• primary care workers
• traumatic stress
• anxiety
• depression
• coping styles

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