Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India—A cross-sectional study
Authors: Menon Geetha R. , Yadav Jeetendra , Aggarwal Sumit , Singh Ravinder , Kaur Simran , Chakma Tapas , Periyasamy Murugesan , Venkateswaran Chitra , Singh Prashant Kumar , Balachandar Rakesh , Kulkarni Ragini , Grover Ashoo , Mishra Bijaya Kumar , Viray Maribon , Devi Kangjam Rekha , Singh K. H. Jitenkumar , Saha K. B. , Barde P. V. , Thomas Beena , Suresh Chandra , A. Dhanalakshmi , Watson Basilea , Selvaraj Pradeep , Xavier Gladston , John Denny , Menon Jaideep , Philip Sairu , Mathew Geethu , David Alice , Vaman Raman Swathy , Sushan Abey , Singh Shalini , Jakhar Kiran , Ketharam Asha , Prusty Ranjan , Kishore Jugal , Venkatesh U. , Kumar Subrata , Kanungo Srikanta , Sahoo Krushna , Swain Swagatika , Lyngdoh Anniesha , Diengdoh Jochanan , Syiemlieh Phibawan , Sarkar AbuHasan , Velhal Gajanan , Kharnare Swapnil , Nandanwar Deepika , Rao M. Vishnu Vardhana , Panda Samiran 
Published: March 2022

Background
COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India.

Methods
A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers.

Results
Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66–3.41), income≥20000(AOR = 1.74, 95% CI, (1.16–2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09–2.46), contact tracing (AOR = 2.05, 95% CI (1.1–3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14–6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28–2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions).

Conclusion
The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.