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 Table of Contents  
Year : 2020  |  Volume : 26  |  Issue : 2  |  Page : 135-138

Strategies to mitigate psychosocial stress among health-care workers during COVID-19 Pandemic

1 Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
2 Department of General and Laparoscopic Surgery, Paret Mar Ivanios Hospital, Kottayam, Kerala, India
3 Department of General Surgery, Government Medical College, Ernakulam, Kerala, India

Date of Submission27-Jul-2020
Date of Acceptance12-Aug-2020
Date of Web Publication07-Nov-2020

Correspondence Address:
Dr. Toney Jose
Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ksj.ksj_9_20

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The COVID-19 pandemic has resulted in increased workplace demands from the health-care workers. This along with other psychosocial factors has resulted in increased stress, anxiety and depression. Measures have to be adopted to prevent burnout in the long run. There are various strategies that can be taken at the individual, administrative and community levels to mitigate stress. Everyone involved in healthcare from frontline workers to administrators and policymakers should be aware of the reasons for stress and strategies to mitigate it. A combined effort would decrease the inevitable toll on the health system. Strategies at individual, administrative and community levels can decrease the stress on health-care workers.

Keywords: COVID, mental health, psychosocial, stress

How to cite this article:
Jose T, Mani J, John J. Strategies to mitigate psychosocial stress among health-care workers during COVID-19 Pandemic. Kerala Surg J 2020;26:135-8

How to cite this URL:
Jose T, Mani J, John J. Strategies to mitigate psychosocial stress among health-care workers during COVID-19 Pandemic. Kerala Surg J [serial online] 2020 [cited 2022 Aug 10];26:135-8. Available from: http://www.keralasurgj.com/text.asp?2020/26/2/135/300248

  Introduction Top

Ever since the first reported case of coronavirus in China in December 2019, the SARS-CoV-2 has spread over the globe. With over 15,785,641 cases and over 640,016 deaths world over, the SARS-CoV-2 is putting an enormous amount of pressure in each and every sector.[1] The essential service workers who are on the frontline in the battle against the virus are faced with an even higher stress. The psychosocial stresses faced by essential workers, especially health-care workers (HCWs), have come to surface. There is an increasing prevalence of anxiety, depression and stress among HCWs. In Singapore, 14.5% of HCWs were found to have worry, 8.9% screened positive for depression, 6.6% had tension and 7.7% had concerns for post-traumatic stress disorder. Non-medical HCWs were found to be more affected than medical HCWs.[2] Even among HCWs, those directly involved in caring of COVID-19 patients, especially those involved in the ICU care were seen to have higher rates of insomnia, stress, anxiety and depression.[3] This article aims to throw light on the reasons for increased stress and the various strategies to mitigate it.

  Reasons for Stress among Health-Care Workers Top

There are multiple reasons for the increased level of stress among HCWs [Table 1]. The highly demanding hospital environment is always known to be stressful. The pandemic has made work in hospitals even more stressful than before. The treatment of both COVID-19 patients and non-COVID patients has evolved drastically with added precautions and protocols. The personnel protective equipment (PPE) that is used to protect oneself is quite uncomfortable. Continuing high-performance tasks in such conditions of limited vision, difficult breathability and decreased manoeuvrability is difficult. The PPE use is continued through the shift – meaning that restrictions are involved with regard to rest, hydration and self-care. Extra precautions are needed in donning and doffing to decrease exposure. Strategies to decontaminate oneself add extra logistic and psychological burden. With rising rates of infection, the hospitals, both the wards and intensive care units are overflowing. This asks for increasing effort from HCWs, increasing their work hours. The donning and doffing protocols and extra precautions that need to be taken also consume a good proportion of time. HCWs themselves are at risk of infection. There is a higher rate of infection among HCWs than among the general public. The various atypical presentations and the diagnosis of COVID-19 following death in non-suspects make the HCWs question their safety. When co-workers get infected because of their duties and some of them develop complications and some die, the morale of the unit decreases. There is a transfer from a doctor role to a patient role which many are not able to handle.
Table 1: Reasons for increased levels of stress in health-care workers

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The health worker is always worried about taking infection to the family. Various decontamination strategies are currently being practised. The effort of alternative living arrangements including isolation from family members and kids will result in lack of social contact and depression. Many small kids are not able to comprehend why their parents choose to stay away. Sometimes, the HCWs are faced with discrimination from their own family and neighbours. The stigma and misinformation leads them to consider HCWs as spreaders of the virus. Some homeowners have asked HCWs to evacuate from their accommodation. The HCWs are faced with an unprecedented situation where they have to utilise the available resources rationally. This results in some patients requiring aggressive treatment being undertreated because of the lack of resources. The life and death situations play a huge impact on the morale of the treating unit.

  Strategies to Decrease Stress among Health-Care Workers Top

Various strategies can be considered to reduce the mental stress among the HCWs. These may be at the (1) individual level (2) administrative level and (3) community level [Figure 1].
Figure 1: Various coping strategies available to decrease the psychosocial stress and improve the mental health among health-care workers. The strategies are at individual, administrative and community levels

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Coping strategies at individual level

A conscious effort should be made by the HCWs to improve their mental health.

  • Have a daily routine – including exercise, eating and properly timed adequate sleep
  • Incorporate exercise to daily life – plays an important role in improving immunity and general health. It also calms the mind and improves general well-being
  • Take adequate rest and food during and after shifts
  • Have adequate information and training in protocols
  • Having information and training alleys fear. HCWs should know about the situation and all current information on the pandemic. They should be trained in the proper usage of PPE and other precautions.

  • Maintain social contact with friend and relatives

    • While social distancing is the norm, effort should be made to maintain contact with friends and family. Technology should be made use of. Face timing, video conferencing, etc., should be increased. Especially those under isolation should maintain contact
    • Online gaming, use of multiplayer features, etc., can be used to give a communal feel and bonding experience.

  • Discuss the situation with family, especially the elderly and kids

    • It is important for the family and kids to understand the situation that the HCWs face. The open discussion should be made with regard to precautions and isolation. The plans made to combat the situation should involve the input of family members. This will help decrease their worry and also avoid any misinformation and inadvertent discrimination. The HCWs should also make up a plan to be executed in case they come under investigation.

  • Practice of yoga and meditation

    • Practicing relaxation techniques and meditation would calm the mind. Mental health, physical health and immunity are improved by practicing yoga.[4],[5] Various organisations are providing access to guided meditation and yoga services through various platforms.

  • Communicate with co-workers – help each other

    • Co-workers face similar situations and would understand and maybe able to provide solutions
    • Furthermore, there might be some who are deeply stressed yet not communicating. If you are able to incite a conversation with them, then they would be helped.

  • Maintain communication with team leader

    • Maintaining active communication with the team leader will help in resolving worries about the protocols, protective equipment, etc., They will be able to direct you to psychosocial services as well
    • Specific scenarios such as immunosuppression and comorbidities need to be communicated to the team leader so that the HCW may undertake a lower risk role.

  • Use of psychological hotlines and psychosocial support measures

    • Institutions are establishing psychological hotlines and support services. The HCWs should take full advantage of these facilities. There should not be any stigma in taking use of these facilities. Remember, it is not a race, it is a marathon.

  • Avoid unhelpful strategies

    • In face of stress, people incline towards unhelpful coping methods such as smoking, drinking and use of drugs. Not only are these methods harmful for the health but they may also compromise the safety precautions taken and increase the risk for infection.

  • Engage in religious activities (if you are a religious person)

    • Religious people may engage themselves in pious activities, which might provide calmness and improved mental health.

  Strategies at the Administrative Level Top

The administration has an important role in decreasing the level of stress and improving the overall mental health of the HCWs. The steps taken by the administration should be directed towards decreasing the fear component among the staff. Uncertainty is among the most important cause for fear. Having a healthy workforce is of prime importance to health-care institutions. It is important to remember that the current situation would not be gone overnight and focus should be on long-term sustainability. The administrative setup of a health-care institution should realise its importance and consider measures in this direction.

  • Provide adequate information and training to HCWs and maintain an adequate supply of protective equipment and sanitisers

    • Ensuring training and protection will decrease the fear of infection and transmission and improve the overall mental health. Team leaders should be able to provide the adequate and latest information to the HCWs for better performance and safety.

  • Having protocols in place for HCWs who come under investigation and proper knowledge of the steps to be followed in such situation is important
  • Maintenance of staff roster to decrease the workload

    • The staff roster should be maintained such that HCWs are rotated from high-stress to low-stress areas. HCWs with special considerations such as immunosuppression and comorbidities should be given roles that do not increase their chance of infection.
    • Administrations should be considerate towards HCWs with high-risk dependents and provide appropriate roles for them

  • Team junior staff with senior staff

  • This will decrease the stress among the inexperienced junior workforce and provide for a stress-free and comfortable work environment.

  • Regular psychological assessment

    • There should be a facility for on-request psychosocial support for any HCW.
    • Similarly, there should be provision for regular psychological assessment and support for all HCWs. This will decrease the avoidance of on-request facilities due to the associated stigma.
    • Support should be provided to all levels of employees – from frontline workers to those in managerial positions.

  • Provide facilities for isolation

    • HCWs who wish to isolate themselves from families during working in high-risk environment should be provided facility for isolation. A similar facility maybe extended when the HCW becomes under investigations or in unfortunate event of contracting SARS-CoV-2.

  • Avoid spread of rumours – only authentic information should be passed on by HCWs
  • Have team meetings and debriefing

    • Team meeting to discuss new information, patient outcomes and any unfortunate event will improve the bonding within the team and decrease stress.

  • Buddy system

    • Designating a workplace buddy to keep check on each other can help early detection of stress and depression. Buddy system with weekly or on demand reporting can help in this regard.

  • Establish psychosocial support services and hotlines that can be accessed through telecommunication methods. Special support services should be there for those HCWs who come under investigation and those becoming positive
  • Special considerations for HCWs with high risks such as immunosuppression and comorbidities.

    • Provision of a low-risk role during the pandemic and facilities for isolation should be considered at the administrative level.

  Strategies at Community Level Top

In the pandemic, many societies have come in support of HCWs by various gestures. However, there have also been situations where the HCWs have been discriminated upon. This is because of the misinformation of the public and their apprehension. However, this greatly increases the stress for the already overworked HCWs. Steps should be taken at the community level to decrease the stigma and hatred towards HCWs and increase appreciation of their efforts. However, the measures require the active participation of the authorities and the media.

  • Provide adequate information about the pandemic and allay fears of the community
  • Provide positive information to the community on the sacrifices by health-care personnel and campaign for support for health-care personnel
  • Financial support to health-care institutions for proper functioning and procurement of protective equipment
  • Prohibition of hurtful activities like eviction of HCWs from accommodation
  • Avoid steps that decrease the morale of HCWs – some institutions have resorted to withheld/reduce the salaries of HCWs. Such actions would decrease the morale of overworked HCW and should be avoided
  • Incentives and bonuses for HCWs involved in care may be decided at the administrative level.

  Conclusion Top

The world as a whole is faced with unprecedented situation. The essential workers including HCWs have an important part to play in remedying the situation. However, the solution would not be reached overnight, but would take months. During this time, HCW burnout has to be prevented. The morale of HCWs has to be maintained. Measures should be taken at individual, administrative and community levels to maintain and improve the mental health of all HCWs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Coronavirus Disease (COVID-19): Situation Report–188. July 26, 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200726-covid-19-sitrep-188pdf? sfvrsn=f177c3fa_2. [Last accessed on 2020 Jul 27].  Back to cited text no. 1
Tan BY, Chew NW, Lee GK, Jing M, Goh Y, Yeo LL, et al. Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann Intern Med 2020;173:317-20.  Back to cited text no. 2
Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic – A review. Asian J Psychiatr 2020;51:102119.  Back to cited text no. 3
Prathikanti S, Rivera R, Cochran A, Tungol JG, Fayazmanesh N, Weinmann E. Treating major depression with yoga: A prospective, randomized, controlled pilot trial. PLoS One 2017;12:e0173869.  Back to cited text no. 4
Lim SA, Cheong KJ. Regular yoga practice improves antioxidant status, immune function, and stress hormone releases in young healthy people: A randomized, double-blind, controlled pilot study. J Altern Complement Med 2015;21:530-8.  Back to cited text no. 5


  [Figure 1]

  [Table 1]


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