Disaster and distress: The double burden. Depression, anxiety, and post-traumatic stress disorder in doctors during the COVID-19 pandemic in Pakistan

Healthcare providers are at a high risk of occupational stress, psychological distress, and mental health issues due to unique job demands. The unprecedented negative impact of the COVID-19 pandemic on healthcare further amplified the risk. We aimed to find out the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in doctors during the COVID-19 pandemic, and explore various associated factors. We conducted a cross-sectional survey among clinicians across tertiary care hospitals in Lahore, Pakistan through online forms/ paper-based questionnaires, using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) Scale, and The Impact of Events Scale-Revised (IES-R) from July-November 2021. Doctors aged 20-60 years working at the public-sector hospitals of Lahore were included through non-probability convenience sampling. The non-parametric Mann-Whitney U and Chi-square test of independence were applied for inferential data analysis in SPSS version 26 at α = 0.05. Of 304 participants, the majority were males (54.6%), from medicine and allied departments (76.9%), junior staff (72%), and front-line workers (75%). 9.5% had a history of psychiatric illness. The prevalence of depression was 25%, anxiety 31.9%, PTSD 15.8%, severe depression 13.8%, and severe anxiety 7.2%. The total median (IQR) scores of depression, anxiety, and PTSD were 5(2-9.5), 4(0-7), and 10(1-23), respectively. Females and junior staff had comparatively severe symptoms of anxiety and depression. Psychiatric history was linked to severe depression (p = 0.003) and PTSD (p=<0.001) but not anxiety (p = 0.136). There were no statistically significant differences in the anxiety and PTSD severity across departments, and between front-line/second-line work. We found high levels of depression, anxiety, and PTSD in our physician sample, even during the 4th COVID-19 wave. This has implications for emphasizing the significance of the mental well-being of healthcare providers and identifying effective interventions to prioritize it even after the pandemic.