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Anxiety Levels of Healthcare Professionals’ Relatives During COVID-19 Pandemic: A Longitudinal Study



Giray Kolcu, Gokmen Ozceylan

Euras J Fam Med 2021;10(1):7-13. doi:10.33880/ejfm.2021100102

 

Original Research


ABSTRACT

Aim: Health workers are the most important risk groups in the last century outbreaks. This situation creates anxiety in the relatives of healthcare workers as well as in healthcare workers. In this study, it was aimed to evaluate the anxiety levels of the relatives of healthcare workers during the COVID-19 epidemic.

Methods: The study was designed as a longitudinal study in quantitative research design. In the study, data were collected regularly every day for 20 days between 20.03.2020-08.04.2020, when the coronavirus pandemic continued, and these data were associated with the data of the Ministry of Health.

Results: One thousand one hundres and eighty participants' opinions were collected for the study. In the study process, it was observed that the anxiety level at 20.03.2020 was 8.25±5.36 and it increased to 17.21±17.07 on 08.04.2020. The relationship between the anxiety level of the participants and the total number of cases the total number of deaths were weak. There was a moderate correlation between the number of deaths per day and the number of patients recovering per day. In the study, it was shown that there is a moderate correlation between the anxiety levels and the level of knowledge of the opinion makers. In this upward trend, it has been observed that there are 3 breaking points: 23-24.03.2020, 28-29.03.2020 and 05-06.04.2020.

Conclusion: In our study described the first cases of anxiety in the vicinity of 20 health workers in Turkey after the first day (twenty) were found to correlate with increased number of deaths in days. It was observed that anxiety level correlated weakly with the total number of cases / deaths, but moderately with the number of daily deaths / recovered patients in the relatives of the health studies. This situation was interpreted as that although the anxiety of healthcare workers was affected by the process, it was more affected by daily changes. Relatives as well as healthcare professionals also experienced a manageable anxiety during the COVID-19 outbreak. We believe that information and rehabilitation programs should be developed for the relatives of healthcare professionals in order to maintain the resilience / resiliency of healthcare professionals.

Keywords: anxiety, coronavirus, pandemics, Family Medicine


Introduction

The increase in the level of anxiety is expected during pandemics. Occupational groups, who had the highest contact with patients, have always been the most important risk group during the outbreaks within the last century (1,2). Among those who were affected by the outbreak of SARS, which emerged in the Guangdong region of China during the fall in 2002, 30% were health professionals who treated the patients as well as the families of these health professionals (3).

Having emerged in China in December 2019, the COVID-19 disease, which is known to spread through droplets and close contact, has now turned into a pandemic. Looking at the data on the COVID-19 pandemic in China, where it was first encountered, various studies demonstrated that the disease risk was higher in health professionals when compared to other occupational groups (4–6).

This stemmed from the fact that the health professionals had close contact with the patients and were exposed to high levels of viral load due to their profession (7,8). An increase in the level of anxiety could be predicted in the relatives of the health professionals as soon as they are acknowledged about the case (2,8,9). 

The aim of this study is to monitor the level of anxiety in the first-degree relatives of the primary healthcare professionals during the outbreak, and highlight the importance of practices for primary healthcare professionals in the management of pandemics.

Methods

The study was designed as a longitudinal study in the quantitative research design. The approval for this study was granted by Süleyman Demirel University Non-Invasive Clinical Research Ethics Committee. The population of the study was determined as the relatives of the family physicians, family medicine specialists, family health workers in Turkey (n=483).  

In the study, data were collected regularly for 20 consecutive days during the coronavirus outbreak between 20 March 2020 and 08 April 2020. Our study was based on data reported daily by the Republic of Turkey Ministry of Health on the pandemic.

In the study, Beck Anxiety Inventory (BAI) was chosen to identify the level of anxiety. BAI is a self-assessment scale that was developed by Beck et al. (10) to identify the frequency of anxiety symptoms experienced by individuals. It is a Likert-type scale composed of 21 items scored between 0-3. The reliability and validity of the inventory in Turkish was conducted by Ulusoy et al. (11).

This inventory was sent to participants as an online form along with the demographic data. MS-Excel, SPSS and EduG package software were used for the statistical analysis. Since it did not have a normal distribution according to the Kolmogorov–Smirnov test, Spearman correlation analysis was used. 

According to the data of the study, which were analyzed using the G-theory, the greatness of the relative value in the estimated percentage of variance component for individuals (41.2%) indicated that the scores had high representation powers (distinctiveness) for the population. The fact that the estimated percentage of variance component for the items was 14.7% and it was relatively lower than the individuals suggested that item difficulties were similar. The fact that the estimated percentage of variance component for the individual-item (44.1%) was a large variance component demonstrated that systematic/non-systematic errors were low (Table 1). 

Table 1. Evaluation of Beck Anxiety Inventory with G-theory 

 

 

 

 

Components

Source

SS

df

MS

Random

Mixed

Corrected

%

SE

B

9191.32413

1075

8.55007

0.38738

0.38738

0.38738

41.2

0.01755

M

2974.72544

20

148.73627

0.13784

0.13784

0.13784

14.7

0.04168

BM

8924.03647

21500

0.41507

0.41507

0.41507

0.41507

44.1

0.00400

Total

21090.08603

22595

 

 

 

 

100

 

 

In the reliability analysis of the scale, Cronbach's alpha value was calculated as 0.95; and, G-coefficient based on the G-theory was calculated as 0.95. In this context, it was demonstrated that the scale was fit for the population and could be generalized.

Results

Opinions were obtained from 1180 participants for the study. After the cleansing of the data, 1076 opinions were included in the analysis. Among the opinions, 42.5% (n=619) belonged to the females while 57.5% (n=457) belonged to the males. The mean age of those who shared their opinions was found to be 35.97±13.32 (min=18, max=73). The participants were asked to express their opinions for 20 consecutive days, and the mean number of opinions was 53.80±33.43 (min=7, max=125). 

In descriptive analyses of the BAI chosen for the present study, it was observed that the majority of participants tended to respond with "not at all" or "mildly" (Table 2).  

Table 2. Descriptive analysis of Beck Anxiety Inventory

 

Not at all

 

n (%)

Mildly but it didn’t bother me much

n (%)

Moderately It wasn’t pleasant at times

n (%)

Severely- it bothered me a lot

 n (%)

Mean

±

Sd

Item 1

740 (68.8%)

222 (20.6%)

99 (9.2%)

15(1.4%)

0.43

±

0.71

Item 2

628 (58.4%)

271(25.2%)

141 (13.1%)

36(3.3%)

0.61

±

0.83

Item 3

725 (67.4%)

214 (19.9%)

114 (10.6%)

23 (2.1%)

0.47

±

0.76

Item 4

505 (46.9%)

253 (23.5%)

178 (16.5%)

140 (13.0%)

0.95

±

1.07

Item 5

207 (9.2%)

338 (31.4%)

270 (25.1%)

261 (24.3%)

1.54

±

1.05

Item 6

669 (62.2%)

253 (23.5%)

115 (10.7%)

39 (3.6%)

0.55

±

0.82

Item 7

590 (54.8%)

273 (25.4%)

143 (13.3%)

70 (6.5%)

0.71

±

0.92

Item 8

711(66.1%)

212 (19.7%)

104 (9.7%)

49 (4.6%)

0.52

±

0.84

Item 9

443 (41.2%)

303 (28.2%)

177 (16.4%)

153 (14.2%)

1.03

±

1.06

Item 10

256 (23.8%)

358 (33.3%)

250 (23.2%)

212 (19.7%)

1.38

±

1.05

Item 11

629 (58.5%)

244 (22.7%)

121 (11.2%)

82 (7.6%)

0.68

±

0.94

Item 12

780 (72.5%)

168 (15.6%)

102 (9.5%)

26 (2.4%)

0.41

±

0.76

Item 13

855 (79.5%)

158 (14.7%)

47 (4.4%)

16 (1.5%)

0.27

±

0.61

Item 14

576 (53.5%)

260 (24.2%)

123 (11.4%)

117 (10.9%)

0.79

±

1.02

Item 15

712 (66.2%)

230 (21.4%)

83 (7.7%)

51 (4.7%)

0.51

±

0.83

Item 16

442 (41.1%)

293 (27.2%)

181 (16.8%)

160 (14.9%)

1.05

±

1.08

Item 17

295 (27.4%)

368 (34.2%)

227 (21.1%)

186 (17.3%)

1.28

±

1.04

Item 18

576 (53.5%)

227 (21.1%)

169 (15.7%)

104 (9.7%)

0.81

±

1.02

Item 19

964 (89.6%)

90 (8.4%)

19 (1.8%)

3 (0.3%)

0.12

±

0.40

Item 20

739 (68.7%)

216 (20.1%)

93 (8.6%)

28 (2.6%)

0.45

±

0.75

Item 21

741 (68.9%)

212 (19.7%)

85 (7.9%)

38 (3.5%)

0.46

±

0.78

 

The total number of tests performed as of 08.04.2020 was calculated to be 247768; the mean number of tests performed per day between 27 March 2020 and 08 April2020 was calculated as 15.959±5.947 (min=7533, max=24900); the total number of cases as of 08 April 2020 was 38226, while the mean number of cases per day during the study period was found to be 1893±1261 (min=311, max=4117). As of 08 April 2020, the total number of intensive care patients was reported to be 1492 while the total number of intubated patients was 995, and the total number of deaths was 812. Within the study period, the mean number of deaths per day was calculated as 40±30 (min=5, max=87); and the mean number of recovered patients per day between 27 March 2020 and 08 April 2020 was 284±197 (min=42, max=786).

The mean acknowledgement levels of the participants of the study was found to be 8.24±1.62 (min=1, max=10) and the mean of their anxiety levels was found to be 15.12±13.39 (min=0, max=63) (Table 3).

Table 3. Daily pandemic data, knowledge level and descriptive data of anxiety level

Date

Total Tests (n)

Daily Tests (n)

Total Cases (n)

Daily Cases (n)

Total Intesive Care Patients (n)

Total Entubated Patients (n)

Total Deaths (n)

Daily Deaths (n)

 

Daily Healing Number (n)

Knowledge Level Mean±Sd

Anxiety Level

Mean±Sd

20.03.2020

 

 

670

311

 

 

9

5

 

7.50±1.19

8.25±5.36

21.03.2020

 

 

947

277

 

 

21

12

 

7.94±1.75

13.47±11.57

22.03.2020

 

 

1236

289

 

 

30

9

 

8.23±1.68

15.33±13.79

23.03.2020

 

 

1529

293

 

 

37

7

 

8.20±1.39

12.53±9.51

24.03.2020

 

 

1872

343

 

 

44

7

 

7.21±2.15

10.85±6.38

25.03.2020

 

 

2433

561

 

 

59

15

 

8.45±1.63

15.70±12.56

26.03.2020

 

 

3629

1196

 

 

75

16

 

8.19±1.54

15.05±16.18

27.03.2020

47823

7533

5698

2069

344

241

92

17

42

9.05±1.08

15.05±16.18

28.03.2020

55464

7641

7402

1704

445

309

108

16

70

8.07±1.77

13.41±11.01

29.03.2020

65446

9982

9217

1815

568

394

131

23

105

8.31±1.66

18.31±18.22

30.03.2020

76981

11535

10827

1610

725

523

168

37

162

8.16±1.67

14.32±11.57

31.03.2020

92403

15422

13531

2704

847

622

214

46

243

7.84±1.88

14.90±13.61

01.04.2020

106799

14396

15679

2148

979

692

277

63

333

8.44±1.77

17.20±15.94

02.04.2020

125556

18757

18135

2456

1101

783

356

79

415

8.56±0.99

17.21±17.07

03.04.2020

141716

16160

20921

2786

1251

867

425

69

484

8.30±1.25

18.07±17.27

04.04.2020

161380

19664

23934

3013

1311

909

501

76

786

8.41±1.68

18.13±15.36

05.04.2020

181445

20065

27069

3135

1381

935

574

73

256

8.66±1.19

14.30±14.80

06.04.2020

202845

21400

30217

3148

1415

966

649

75

284

8.54±1.38

16.12±15.99

07.04.2020

222868

20023

34109

3892

1474

987

725

76

256

8.32±1.16

14.70±13.83

08.04.2020

247768

24900

38226

4117

1492

995

812

87

264

8.22±1.63

15.25±13.15

 

In the study, no significant relationship was found between the acknowledgement levels of the participants and the total number of tests performed as of 08 April 2020, the number of tests per day between 27 March 2020 and 08 April 2020, the total number of cases as of 08 April 2020, the total number of intensive care patients as of 08 April 2020 as well as the total number of intubated patients. 

In the study, a weak correlation was found between the acknowledgement levels of the participants and the total number of cases per day during the research period (p=0.024, r=0.504) as well as the total number of deaths (p=0.023, r=0.505); and, a moderate correlation was found between the acknowledgement levels of the participants and the number of deaths per day during the research period (p=0.011, r=0.554). 

In the study, no significant relationship was found between the anxiety levels of the participants and the total number of tests performed as of 08 April 2020, the number of deaths per day between 27 March 2020 and 08 April 2020, the total number of cases as of 08 April 2020, the total number of intensive care patients as of 08 April 2020 as well as the total number of intubated patients. 

In the study, a weak correlation was found between the anxiety levels of the participants and the total number of cases  (p=0.036, r=0.472) during the study period, the total number of deaths (p=0.036, r=0.472); and a moderate correlation was found between the anxiety levels of the participants and the number of deaths per day (p=0.008, r=0.577) during the study period as well as the number of recovered patients per day between 27 March 2020 and 08 April 2020 (p=0.005, r=0.602). In the study, it was demonstrated that there was a moderate correlation between the acknowledgement levels and the anxiety levels of those who shared their opinions (p=0.004, r=0.605) (Table 4).

Table 4. Relationship between anxiety levels, knowledge level and pandemic data*

Spearman’s rho

Total Tests

Daily Tests

Total Cases

Daily Cases

Total Intesive Care Patients

Total Entubated Patients

Total Deaths

Daily Deaths

 

Daily Healing Number

Knowledge Level

Anxiety

Level

Anxiety

Level

Correlation Coefficient

0.077

0.060

0.472

0.438

0.077

0.077

0.472

0.577

0.602

0.605

-

Sig. (2-tailed)

0.803

0.845

0.036

0.054

0.803

0.803

0.036

0.008

0.005

0.004

-

Knowledge Level

Correlation Coefficient

0.132

0.165

0.505

0.504

0.132

0.132

0.505

0.554

 

-

0.605

Sig. (2-tailed)

0.668

0.590

0.023

0.024

0.668

0.668

0.023

0.011

 

-

0.004

*Spearman correlation test

When the pandemic data and the anxiety levels were analyzed on the chart in our study, three break points were observed on the anxiety level on 23-24 March 2020, on 28-29 March 2020 and on 05-06 April 2020. When the important events that could have social effects during these dates were analyzed, it was found that the preventive decisions for the fight against the COVID-19 pandemic were announced after the World Health Organization declared it as a pandemic on 23-24 March 2020; Ministry of Health coronavirus monitoring system started online on 27-28 March 2020; and decisions on primary healthcare services were taken on 05-06 April 2020 (Figure 1).

Figure 1. The relationship between anxiety levels and pandemic data

Discussion

Pandemic periods cause an intense anxiety in society along with the fear of disease, spreading, news on death, uncertainty, social isolation and even curfews (2,7,8,12). Government policies are the determinants in the management of these anxieties (13). 

One of the determinants of anxiety in pandemic periods is the level of acknowledgement. In this context, in order to reduce anxiety, it is rather important for individuals to have access to transparent information about the process and be able to foresee their future. Intensive acknowledgement efforts of our country enabled the acknowledgement levels in the relatives of the healthcare professionals to reach a good level. It was observed that anxiety level correlated weakly with the total number of cases/deaths, but moderately with the number of daily deaths/recovered patients in the relatives of the health studies. This situation was interpreted as that although the anxiety of healthcare workers was affected by the process, it was more affected by daily changes. Looking at the correlation between the acknowledgement level and anxiety level found in our study, we can interpret the acknowledgement process as one of the important tools in anxiety management.  

In our study, when the pandemic data and the anxiety level are evaluated on the chart, it is seen that there are three breaking points at the anxiety level: 23-24 March 2020, 28-29 March 2020 and 05-06 April 2020. Announcement of the measures to combat the COVID-19 pandemic following the pandemic announcement by the World Health Organization on 23-24 March 2020, the Ministry of Health coronavirus tracking system website announced online on 27-28 March 2020. It was determined that decisions were taken on the delivery of primary health care services on 05-06 April 2020.

In our country, two important attitudes of the Ministry of Health significantly reduced anxiety in healthcare professionals and their relatives. The first one was the decision of the Ministry of Health to disclose all data related to the pandemic every day transparently; and the second now was the provision of supportive approaches for healthcare professionals. The most important of these approaches were the procurement of protective equipment for healthcare professionals, public support for healthcare professionals and discussion of the law on violence against healthcare professionals. This positive climate was reflected in healthcare professionals and significantly reduced anxiety in their relatives. 

The tradition of the Republic of Turkey on fighting against communicable diseases has contributed to the public health within this pandemic period. Many international institutions have stated that the COVID-19 pandemic process was well-managed in our country. The reaction of the Ministry of Health in protective approaches for healthcare professionals has decreased their anxiety about the pandemic; therefore, this was reflected on their relatives as well. Healthcare services require a major self-devotion during pandemics. Anxiety management in the relatives of the healthcare professionals would contribute to the management of the pandemic by affecting the attention and motivations of the healthcare professionals during their service. We believe that increasing the protective measures for healthcare professionals would increase their morale and motivations, reduce the anxiety levels in relatives and would encourage them to continue to take part in the fight against the pandemics more effectively. 

In our study, it was concluded that anxiety has increased in Turkey in correlation with the number of deaths within the period of 20 days since the first case was reported. When the number of cases per day in China was analyzed, it was observed that the number of cases and deaths peaked within approximately four and five weeks. It was found that the peak time lasted six to eight weeks in European countries. When the number of cases peaked in these countries, the mean number of cases per day varied between 500 and 1000 (14). Our study was limited to the first twenty days. The mean number of cases per day peaked at 90 within these twenty days. In case the number of deaths progresses as in China and European countries and in case the deaths per day would reach five hundred in the sixth and eighth weeks, we could predict that the anxiety level would increase more.

Conclusion

Relatives as well as healthcare professionals also experienced a manageable anxiety during the COVID-19 outbreak. We believe that information and rehabilitation programs should be developed for the relatives of healthcare professionals in order to maintain the resilience of healthcare professionals..

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How to cite: Kolcu G, Ozceylan G. Anxiety levels of healthcare professionals’ relatives during COVID-19 pandemic: a longitudinal study. Euras J Fam Med 2021;10(1):7-13. doi:10.33880/ejfm.2021100102.


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