PLOS ONE
RESEARCH ARTICLE
Psychological distress among health service
providers during COVID-19 pandemic in Nepal
Khagendra Kafle ID1, Dhan Bahadur Shrestha ID2*, Abinash Baniya ID3,
Sandesh Lamichhane ID3, Manoj Shahi ID3, Bipana Gurung ID3, Partiksha Tandan ID3,
Amrita Ghimire4, Pravash Budhathoki5
1 Department of Psychiatry, Chitwan Medical College Teaching Hospital (CMCTH), Chitwan, Nepal,
2 Mangalbare Hospital, Morang, Nepal, 3 Chitwan Medical College Teaching Hospital (CMCTH), Chitwan,
Nepal, 4 Department of Psychiatric Nursing, Chitwan Medical College Teaching Hospital, Chitwan, Nepal,
5 Dr Iwamura Memorial Hospital, Bhaktapur, Nepal
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* medhan75@gmail.com
Abstract
Background
OPEN ACCESS
Citation: Kafle K, Shrestha DB, Baniya A,
Lamichhane S, Shahi M, Gurung B, et al. (2021)
Psychological distress among health service
providers during COVID-19 pandemic in Nepal.
PLoS ONE 16(2): e0246784. https://doi.org/
10.1371/journal.pone.0246784
Editor: Simone Savastano, Fondazione IRCCS
Policlinico San Matteo, ITALY
Received: October 31, 2020
Accepted: January 26, 2021
Published: February 10, 2021
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
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editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0246784
Copyright: © 2021 Kafle et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the manuscript and its Supporting
information files.
COVID-19 pandemic has provoked a wide variety of psychological problems such as anxiety, depression, and panic disorders, especially among health service providers. Due to a
greater risk of exposure to the virus, increased working hours, and fear of infecting their families, health service providers are more vulnerable to emotional distress than the general
population during this pandemic. This online survey attempts to assess the psychological
impact of COVID-19 and its associated variables among healthcare workers in Nepal.
Materials and methods
For data collection purposes, Covid-19 Peritraumatic Distress Index (CPDI) Questionnaire,
was used whose content validity was verified by Shanghai mental health center. Data for the
survey were collected from 11 to 24 October 2020 which was extracted to Microsoft Excel13 and analyzed.
Results
A total of 254 health care workers from different provinces of the country participated in this
study with a mean age of 26.01(± 4.46) years. A majority 46.9% (n = 119) of the participants
were not distressed (score �28) while 46.5% (n = 118) were mild to moderately distressed
(score >28 to �51) and 6.7% (n = 17) were severely distressed (score �52) due to the current COVID-19 pandemic. Female participants (p = 0.004) and participants who were doctors by profession (p = 0.001) experienced significantly more distress.
Conclusions
COVID-19 pandemic has heightened the psychological distress amongst health care service providers. The findings from the present study may highlight the need for constructing
and implementing appropriate plans and policies by relevant stakeholders that will help to
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Funding: The author(s) received no specific
funding for this work.
Psychological distress among health service providers
mitigate the distress among health service providers in the current pandemic so that we can
have an efficient frontline health workforce to tackle this worse situation.
Competing interests: The authors have declared
that no competing interests exist.
Introduction
The Coronavirus disease 2019 (COVID-19), as named by the World Health Organization
(WHO), first emerged as a cluster of unknown pneumonia cases in Wuhan in late December
2019 [1, 2]. This outbreak had spread substantially throughout the world for which it was
declared as a Public Health Emergency of International Concern (PHEIC) on 30th January
2020 and as a pandemic by the World Health Organization (WHO) on March 11, 2020 [3, 4].
As of October 29, 2020, COVID-19 has accounted for 43,766,712 confirmed cases and
1,163,459 deaths across 219 territories [5]. Nepal registered its first case of COVID-19 on January 23, 2020. Despite adopting operative measures like nationwide lockdown, social distancing,
and travel restrictions, the COVID-19 cases are in increasing trend in Nepal. Till October 29,
2020, there have been 164,718 confirmed cases of COVID-19, of which 124,862 (75.8%) had
recovered and 904 (0.6%) deaths have been recorded [6].
The current COVID-19 pandemic has not only caused significant threats to people’s physical health and lives but has also provoked a wide variety of psychological problems such as anxiety, depression, and panic disorders [7]. During acute health crises like the current COVID19 pandemic, healthcare systems and facilities are under extreme pressure for providing
appropriate diagnostic and treatment services due to which the working life of health service
providers in affected regions has become more stressful than normal [8]. Health service providers who are working as front liners in the current pandemic are more vulnerable to emotional distress than the general population as they have a greater risk of exposure to the virus,
increased workload/working hours, fear of infecting their family and friends, lack of experience in managing the disease, perceived stigma, significant lifestyle changes, social discrimination and lack of personal protective equipment (PPE) [9–12]. The increased infection rate
among healthcare workers is another important cause of such psychological impact [13].
During this crucial period, a more comprehensive understanding of the psychological burden among different groups of health service providers is essential so that appropriate psychological support could be provided and also strengthening mental healthcare could be done
[14]. This cross-sectional study attempts to assess the psychological impact of COVID-19 and
its associated variables among different healthcare workers in Nepal.
Materials and methods
This study is a nationwide, web-based cross-sectional survey of psychological distress among
health service providers during the COVID-19 pandemic in Nepal. Data for the survey were
collected from 11 to 24 October 2020. The survey was filled by health professionals working in
various institutes like hospitals, primary health centers, nursing homes, pharmacies, health
posts and sub-health posts. Hospitals were teaching hospitals, district hospitals, regional hospitals, zonal hospitals and private hospitals. Medical professionals ranged from doctors, nurses,
pharmacists, dentists, auxiliary health workers working in different departments ranging from
intensive care units, wards, emergency departments, pharmacy shops, etc. For data collection
purposes COVID-19 Peritraumatic Distress Index (CPDI) Questionnaire was used whose content validity was verified by Shanghai Mental Health Center [7]. As specified in the International Classification of Diseases, 11th Revision, apart from demographic data (age, gender,
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Psychological distress among health service providers
religion, education, occupation, workload, availability of safety measures, nationality, ethnicity, and residence) the CPDI questionnaire includes relevant diagnostic guidelines for specific
phobias and stress disorders and further inquiries about the frequency of anxiety, depression,
cognitive change, avoidance, and compulsive behavior, physical symptoms and loss of social
functioning in the past week, ranging from 0 to 96. Informed consent was taken from participants at the beginning of the questionnaire. For the survey, data were collected through an
online Google form. Social media network was used to publish structured Google form with
CPDI questions and forms were disseminated via email, messenger, Facebook group, Viber,
etc. to the health care workers requesting them to participate in the survey and also to share
the survey form to a wider audience. The eligible participants for the survey were physicians
(including residents and fellows), advanced practice providers or registered nurses, and other
service providers working at medical centers. Medical students were excluded from this survey
as most of them usually do not enter the stage of clinical practice.
Sample size
The minimum sample size required was 156. Sample size was determined using the formula:
2
N ¼ ½ðzÞ � pð1
p�=e2 ;
where ‘z’ is 1.96 at 95% confidence interval, ‘e’ is margin of error at 5% and ‘p’ is prevalence
rate of 11.5% from a recent study done in Nepal [15]. Adding 10% of the minimum sample as
non- respondent, the desired sample size becomes 172.
Exposure variables
Socioeconomic and demographic variables such as age (<30, 30–45, >45), Gender (male and
female), Religion (non- Hinduism and Hinduism), Education (Diploma, bachelors or masters), employment (Doctor, nurse or other health care worker), Marital status (married,
unmarried, widowed or divorced), Nationality (Nepali, non-Nepali), Ethnicity (Brahmin and
Chhetri, Others), Residence (Province 1,2,3,4,5,6,7) were included in the survey questionnaire.
Outcome variables
This study used the CPDI scale questionnaire with an additional socio-demographic questionnaire and the internal consistency of 24 CPDI variables was assessed by using Cronbach’s α.
Its internal reliability was found to be 0.905 indicating high internal consistency of the scale.
The 5- point Likert scoring system with scales ranging from never-0, occasionally-1, sometimes-2, often-3, always-4 was used. The total score thus calculated is classified as:- score
between 0–28 is normal, 28 and 51 mild or moderate distress and �52 severe distress.
Statistical analysis
Data of the Survey was exported into Microsoft Excel-13. The data then imported, cleaned, categorized as appropriate, and analyzed using SPSS (Statistical Package for Social Science) version-22. For all the variables, a univariate analysis was performed to assess the distribution of
each variable in frequency and the percentage to summarize categorical variables. Odds ratios
of relevant predicting variables were estimated using logistic regression analysis which gives
the relation between a set of predictor set X (exposure variable) and a dichotomous response
variable Y(outcome variable). For ease, we specify the response to be Y = 0 or 1, with Y = 1 designating the occurrence of the event of interest. The outcome variable is No distress = 0 and
distress = 1. The exposure variables were categorical.
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Research ethics
Before the survey, informed consent was obtained from all the respondents. The study was
conducted following the protocol, approved by the ethics committee of Chitwan Medical College Teaching Hospital (letter-number- CMC-IRC/077/078-041).
Results
A total of 257 health care workers participated in this survey. Three forms were incomplete so
excluded and data from 254 participants were included in the analysis. The socioeconomic
and demographic profile of responders is outlined in Table 1. In this study, the majority of
respondents (85.4%) were less than 30 years old and the mean age of participants was 26.01
(±4.46) years. The male to female ratio is 1.01 with 50.04% male participants. The majority of
participants were Hindu by religion (90.2%), Doctor by occupation (42.5%), completed bachelor’s level or master’s level (89.8%), and working in non-government hospitals (72%). Though
most of the respondents work more than 4 days a week (71.1%) and more than or equal to 40
hrs per week (83.5%), almost two-thirds (63.8%) of these health care workers didn’t receive
any extra allowance. Approximately two-thirds of participants are residing in Bagmati province (61.8%).
Table 2 depicts the prevalence of every psychological component of the CPDI scale. More
than two-third (n = 222, 87.4%) used to feel more nervous and anxious. Similarly, 74.8% of
respondents (n = 190) felt insecure and bought a lot of masks, medications, sanitizers, gloves,
and/or other home supplies. About half (n = 120, 47.2%) of the participants always felt sympathetic to COVID-19 patients and their families. Only approximately one third (n = 86, 33.9%)
of the respondents believed the COVID-19 information from all sources without any validation. Approximately two-thirds (n = 170, 66.9%) didn’t believe in negative news about
COVID-19 and was not skeptical about the good news.
Table 3 demonstrates the distribution of severity of psychological distress by socioeconomic
and demographic characteristics of Nepal. The frequency of mild to moderate distress among
age groups <30 years, 30–45 years, and >45 years old were 104, 13, and 1 respectively whereas
14 severely distressed health service providers were below <30 years old. Female participants
were having more distress (n = 80) compared to male participants (n = 55) which were statistically significant (p = 0.004). Additionally, participants who were doctors by profession experienced significantly more distress (n = 50, p = 0.001). Socioeconomic and demographic
characteristics of participants like religion, education level, working hours, marital status, ethnicity, province of residence, and extra allowance were not significantly associated with distress level.
46.9% (n = 119) of the participants were not distressed while 46.5% (n = 118) were mild to
moderate distressed and 6.7% (n = 17) were severely distressed due to COVID-19 pandemic
(Fig 1).
Binary logistic regression analysis taking socio-demographic determinants of distress didn’t
show any significant association (Table 1 in S1 File).
Discussion
A total of 254 health care workers from different provinces of the country participated in this
study with a mean age of 26.01(± 4.46) years. The male to female ratio is 1.01 with 50.4% male
participants. The findings of this study are consistent with another study conducted in Nepal,
where 54.2% were male with a mean age of 27.8 years [16]. Though the survey was completed
by a similar number of male and female participants with doctors and nurses being the largest
two groups, the prevalence of distress among females was found to be higher which is
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Table 1. Socio-demographic profile of the health care workers (N = 254).
Socio-demographic variables
Age
Sex
Religion
Education
Employment
Current Job
Institute category
Work in weeks per month
Duty HRS per week
Use of PPE
Extra allowance
Frequency
Percent
<30
217
85.4
30–45
36
14.2
>45
1
Mean ± SD
26.01±4.46
Women
126
49.6
Men
128
50.4
Non-Hinduism
25
9.8
Hinduism
229
90.2
Diploma
26
10.2
Bachelor or master
228
89.8
Doctor
108
42.5
Nurse
61
24.0
Other HCW
85
33.5
Government
71
28.0
Non-Government
183
72.0
Hospitals or higher center
199
78.3
PHC, Health post, or others
55
21.7
Less than 4 weeks per month
48
18.9
4 weeks per month
206
81.1
.4
Less than 40 hrs
39
15.4
More than or equal 40 hrs
212
83.5
Missing
3
1.2
Complete set
42
16.5
Incomplete
209
82.3
Missing
3
1.2
May be or Yes
89
35.0
No
162
63.8
Missing
3
1.2
Married
38
15.0
Unmarried
214
84.3
Widowed or divorced
2
.8
Nationality
Non-Nepali
3
1.2
Nepali
251
98.8
Ethnicity
Brahmin and Chettri
162
63.8
Others
92
36.2
Province 1 (Biratnagar as territorial capital)
9
3.5
Province 2 (Janakpur as territorial capital)
11
4.3
Province 3 (Bagmati)
157
61.8
Marital status
Residence
Province 4 (Gandaki)
28
11.0
Province 5 (Butwal as territorial capital)
34
13.4
Province 6 (Karnali)
12
4.7
Province 7 (Sudurpaschim)
3
1.2
NB: Nepal is yet to name all the provinces under the mandate of the new constitution and federal People’s Republic
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Table 2. Presence of symptoms COVID-19 peri-traumatic distress (CPDI).
Questions
Never
Occasionally Sometimes Often
Always
n(%)
n(%)
n(%)
n(%)
n(%)
Question 1: Compared to usual, I feel more nervous and anxious.
32(12.6)
45(17.7)
111(43.7)
50
(19.7)
16(6.3)
Question 2: I feel insecure and bought a lot of masks, medications, sanitizers, gloves, and/or other home
supplies.
64(25.2)
50(19.7)
68(26.8)
40
(15.7)
32(12.6)
Question 3: I can’t stop myself from imagining myself or my family being infected and feel terrified and
anxious about it.
39(15.4)
54(21.3)
66(26.0)
55
(21.7)
40(15.7)
Question 4: I feel helpless no matter what I do.
100
(39.4)
57(22.4)
62(24.4)
23(9.1)
12(4.7)
Question 5: I feel sympathetic to COVID-19 patients and their families.
7(2.8)
21(8.3)
39(15.4)
67
(26.4)
120
(47.2)
Question 6: I feel helpless and angry about people around me, governors, and media.
41(16.1)
41(16.1)
75(29.5)
51
(20.1)
46(18.1)
Question 7: I am losing faith in the people around me.
91(35.8)
49(19.3)
68(26.8)
32
(12.6)
14(5.5)
Question 8: I collect information about COVID-19 all day. Even if it’s not necessary, I can’t stop myself.
73(28.7)
63(24.8)
58(22.8)
30
(11.8)
30(11.8)
Question 9: I will believe the COVID-19 information from all sources without any evaluation.
168
(66.1)
36(14.2)
30(11.8)
12(4.7)
8(3.1)
Question 10: I would rather believe in negative news about COVID-19 and be skeptical about the good
news.
170
(66.9)
33(13.0)
31(12.2)
7(2.8)
13(5.1)
Question 11: I am constantly sharing news about COVID-19 (mostly negative news).
172
(66.7)
46(18.1)
28(11.0)
5(2.0)
3(1.2)
Question 12: I avoid watching COVID-19 news since I am too scared to do so.
140
(55.1)
45(17.7)
52(20.5)
12(4.7)
5(2.0)
Question 13: I am more irritable and have frequent conflicts with my family.
140
(55.1)
53(20.9)
42(16.5)
16(6.3)
3(1.2)
Question 14: I feel tired and sometimes even exhausted.
32(12.6)
64(25.2)
94(37.0)
49
(19.3)
15(5.9)
Question 15: When feelings anxious, my reactions are becoming sluggish.
64(25.2)
75(29.5)
61(24.0)
43
(16.9)
11(4.3)
Question 16: I find it hard to concentrate.
58(22.8)
73(28.7)
82(32.3)
31
(12.2)
10(3.9)
Question 17: I find it hard to make any decisions.
71(28.0)
80(31.5)
70(27.6)
22(8.7)
11(4.3)
Question 18: During this COVID-19 period, I often feel dizzy or have back pain and chest distress.
119
(46.9)
57(22.4)
55(21.7)
17(6.7)
6(2.4)
Question 19: During this COVID-19 period, I often feel stomach pain, bloating, and other stomach
discomforts.
129
(50.8)
57(22.4)
56(22.0)
10(3.9)
2(0.8)
Question 20: I feel uncomfortable when communicating with others.
106
(41.7)
61(24.0)
56(22.0)
23(9.1)
8(3.1)
Question 21: Recently, I rarely talk to my family.
145
(57.1)
44(17.3)
41(16.1)
15(5.9)
9(3.5)
Question 22: I have frequent awakening at night due to my dream about myself or my family being
infected by COVID-19.
184
(72.4)
40(15.7)
19(7.5)
5(2.0)
6(2.4)
Question 23: I have changes in my eating habits
98(38.6)
53(20.9)
46(18.1)
36
(14.2)
21(8.3)
Question 24: I have constipation or frequent urination.
173
(68.1)
33(13.0)
28(11.0)
17(6.7)
3(1.2)
114 of the respondents (44.9%) would avoid watching COVID-19 news and a similar percentage of the respondents would be irritable and had a conflict with their
family. More than half (n = 135, 53.1%) of the participants would feel dizzy or have back pain and chest distress and 49.2% of them would feel stomach pain, bloating,
and other stomach discomforts. In addition to this, 58.3% would feel uncomfortable when communicating with others, 61.4% had changes in their eating habits and
31.9% had constipation or frequent urination.
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Table 3. Prevalence of CPDI by socioeconomic and demographic characteristics among HCWs in Nepal.
Socio-demographic Variables
Age
Sex
Religion
Education
Employment
Current Job
Institute category
Work in weeks per month
Duty HRS per week
Use of PPE
Extra allowance
Marital status
Nationality
Ethnicity
Residence
No distress (n)
Mild- moderate distress (n)
Severe distress (n)
<30
99
104
14
30–45
20
13
3
>45
0
1
0
Women
46
69
11
Men
73
49
6
Non-Hinduism
14
9
2
Hinduism
105
109
15
Diploma
8
14
4
Bachelor or master
111
104
13
Doctor
58
46
4
Nurse
16
36
9
Other HCW
45
36
4
Government
40
26
5
Non-Government
79
92
12
Hospitals or higher center
89
97
13
PHC, Health post, or others
30
21
4
Less than 4 weeks per month
19
27
2
4 weeks per month
100
91
15
Less than 40 hrs
20
18
1
More than or equal 40 hrs
97
99
16
Complete
18
24
0
Incomplete
99
93
17
May be or Yes
45
41
3
No
72
76
14
Married
22
14
2
Unmarried
97
102
15
Widowed or divorced
0
2
0
Non-Nepali
2
1
0
Nepali
117
117
17
Others
36
48
8
Brahmin and Chhetri
83
70
9
Province 1 (Biratnagar as territorial capital)
7
2
0
Province 2 (Janakpur as territorial capital)
4
5
2
Province 3 (Bagmati)
68
79
10
Province 4 (Gandaki)
18
10
0
Province 5 (Butwal as territorial capital)
15
16
3
Province 6 (Karnali)
6
5
1
Province 7 (Sudurpaschim)
1
1
1
p-value
.575
.004
.544
.074
.001
.138
.376
.293
.490
.092
.243
.358
.752
.156
.232
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comparable with the outcome of a study conducted in Nepal [15] and Saudi Arabia [17]. Concern for family members and lack of proper knowledge regarding epidemics and public health
emergencies may be the major cause for stress among females pointing towards the critical
role of family and community support for mental health [18]. Higher workload and greater
risk of direct exposure to COVID-19 patients have increased the vulnerability of females especially nurses for mental health [19].
Though it was a nationwide survey, we have a maximum number of participants from Bagmati province. The reason could be, this province includes the national capital city Kathmandu
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Fig 1. Prevalence of psychological distress among HCWs in Nepal.
https://doi.org/10.1371/journal.pone.0246784.g001
and other major cities where comparatively a greater number of health professionals are supposed to be working. Most of the participants were educated till bachelor or higher level. The
majority were working in non-government settings. This is expected as only a small proportion of all health forces are working under government and most of them are employed with
non-government organizations [20].
A survey in China demonstrated that age, occupation, mass media report, and perception
towards outbreak and public health emergencies bring significant variation in psychological
distress among different individuals [21]. Many studies have shown that the risk of psychological problems is relatively more among health care workers than non-health workers as they are
being exposed to patients with COVID-19 [22]. Psychological distress was found to be higher
in doctors than in other HCWs in this study (p = 0.001). Doctors experience higher levels of
mental stress during normal circumstances and health emergencies like COVID-19 exert additional pressure on doctors and the whole health care system [23].
The prevalence of mild distress was reported to be lower among health workers from China
(36.5%) [24] and in Saudi Arabia (33.7%) [17] as compared to the findings of our study. In
addition to this, the prevalence of mild-moderate distress (46.5%) and severe distress (6.7%) in
this study was found to be higher as compared to a recent study conducted in Nepal among
the general population, which showed that 11% of the participants had mild psychological distress while only 0.5% of them reported with severe distress [15]. This might be attributed
greatly to the fact that healthcare workers are facing tremendous pressure from COVID-19
including a high risk of exposure to infection, inadequate protection due to shortage of healthcare resources, long duty hours, perceived stigma, lack of family contact, and the possibility of
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family illness in addition to early and evolving nature of pandemic when the study was conducted [11, 25]. These factors can contribute to psychological problems in a substantial proportion of healthcare workers including depression, anxiety, insomnia, distress, obsessivecompulsive symptoms, and somatization symptoms [24, 26]. Notably, depression and posttraumatic stress symptoms might remain even after crises like the current pandemic are over
[27, 28] and might as well surpass the consequences of the current pandemic itself [14].
The shortage of PPE wasn’t statistically significant in our study, which might be due to
adopting the participants with the current situation. However, several studies have reported
this as a considerable source of distress among healthcare workers [25, 29, 30] and have specified the need to equip these frontline workers with adequate resources which can strengthen
their overall work performance with better psychological outcomes [25, 31]. Lack of protective
measures can create a sense of insecurity and thus imposes the healthcare workers to higher
exposure to infections. Thus, these findings draw attention to the government of Nepal for
providing adequate protective measures to lessen the escalating mental health burden among
healthcare workers [30].
There is generally a higher risk of suicide among healthcare workers as compared to the
general population [32] and COVID-19 has heightened this burden of suicide among healthcare workers [33]. There is no study relating to suicide rates in Nepal. However, a total of 1647
cases of the general population have committed suicide as of 27th June 2020 after the lockdown, which on average is 25% higher as compared to the pre-lockdown period [34]. Further
studies are required to recuperate the magnitude of suicide among healthcare workers.
Expectedly, the findings from this study will help refine our understanding of the influence
of the COVID-19 pandemic on psychological health among different groups of health service
providers and highlight the need for appropriate implementation of plans that will help prevent and manage the distress among health service providers in the current pandemic. Moreover, for short term psychological problems like anxiety, depression, and insomnia, evidencebased psychosocial interventions and support are of utter necessity at the current stage [22].
Limitation
Special consideration should be given while interpreting the data as the study had several limitations. In this online survey, a self-reported questionnaire was used and conducted in a nation
where internet penetration is only 57% [35]. The use of cross-sectional data limits controls
over unobserved heterogeneity among the respondents. It was a nationwide study where only
a limited number of participants were involved. So, the sample may not necessarily be a good
representation of the whole country and the generalizability of finding is limited. Also, there
may be potential changes in distress with the progression of pandemic due to increasing number of cases and mortality. Majority of our participants were young and we did not evaluate
the work experience of these young professionals. Lack of adequate work experience might
have led to more distress. However, we could not determine these association of participant’s
working experience with distress due to lack of data on work experience. This might be
explained by the fact that our survey was online web-based which were easier to fill by young
medical professionals due to their technical expertise, easy access and widespread use compared to old medical professionals.
Conclusions
This was a nationwide, web-based, cross-sectional study conducted to assess the psychological
impact of COVID-19 and its associated factors among different healthcare workers in Nepal.
More than half of health workers were categorized as having ‘mild-to-severe distress’ due to
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the COVID-19 pandemic. Female participants and doctors were having significantly more distress. The findings from the present study may highlight the need for constructing and implementing appropriate plans and policies by relevant stakeholders that will help to mitigate the
distress among health service providers in the current pandemic so that we can have an efficient frontline health workforce to tackle this worse situation.
Supporting information
S1 File. Questionnaire and supplement table.
(DOCX)
Acknowledgments
We would like to acknowledge Binaya Subedi, Pujan K.C. and Matrika Dhital for their assistance in Google form dissemination in social media and also to all the participants for their
active response.
Author Contributions
Conceptualization: Khagendra Kafle, Dhan Bahadur Shrestha, Abinash Baniya, Sandesh
Lamichhane, Manoj Shahi, Bipana Gurung, Partiksha Tandan, Amrita Ghimire, Pravash
Budhathoki.
Data curation: Khagendra Kafle, Dhan Bahadur Shrestha, Abinash Baniya, Sandesh Lamichhane, Manoj Shahi, Bipana Gurung, Partiksha Tandan, Amrita Ghimire, Pravash
Budhathoki.
Formal analysis: Dhan Bahadur Shrestha.
Investigation: Khagendra Kafle, Dhan Bahadur Shrestha, Sandesh Lamichhane, Manoj Shahi,
Bipana Gurung, Partiksha Tandan.
Methodology: Khagendra Kafle, Dhan Bahadur Shrestha, Abinash Baniya, Sandesh Lamichhane, Manoj Shahi, Bipana Gurung, Partiksha Tandan, Amrita Ghimire, Pravash
Budhathoki.
Project administration: Khagendra Kafle, Dhan Bahadur Shrestha, Abinash Baniya, Sandesh
Lamichhane, Manoj Shahi, Bipana Gurung, Partiksha Tandan, Amrita Ghimire, Pravash
Budhathoki.
Resources: Khagendra Kafle, Abinash Baniya, Sandesh Lamichhane, Manoj Shahi, Bipana
Gurung, Partiksha Tandan, Amrita Ghimire, Pravash Budhathoki.
Software: Dhan Bahadur Shrestha.
Supervision: Khagendra Kafle, Dhan Bahadur Shrestha.
Validation: Khagendra Kafle, Dhan Bahadur Shrestha.
Writing – original draft: Khagendra Kafle, Dhan Bahadur Shrestha, Abinash Baniya, Sandesh
Lamichhane, Manoj Shahi, Bipana Gurung, Partiksha Tandan.
Writing – review & editing: Khagendra Kafle, Dhan Bahadur Shrestha, Abinash Baniya, Sandesh Lamichhane, Manoj Shahi, Bipana Gurung, Partiksha Tandan, Amrita Ghimire, Pravash Budhathoki.
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