This cross-sectional study was designed to evaluate the fear and anxiety level among HCWs during COVID-19 pandemic in Saudi Arabia. For this purpose, a questionnaire-based study was formulated to collect information about HCWs fear and anxiety. Survey-based studies are proven for collecting information on participant behaviours, opinions and experiences; however, careful data collection and analysis are required13. The questionnaire used in this study collected information systematically. Any incomplete responses have been discarded.
In pandemics, psychological impacts such as fear and anxiety are natural, especially if the number of infected individuals and death rates is sharply increasing. In this study, data revealed that 10.7%, 73.5% and 15.7% of HCWs had a mild, moderate and severe degree of fear and anxiety, respectively. Several factors are related to moderate to high level of fear and anxiety; these includes personal, social and society. Personal factors are linked with an elevated level of anxiety is being a smoker or living with someone with chronic illness. Social factors are associated with increased exposure to media news and the economic impact of this disease. Society is another aspect of high level of anxiety associated to living with older people having respiratory and immune-mediated disease. Our findings are consistent with other studies conducted on the impact of COVID-19 on HCWs. 14 15
During COVID-19 outbreak, our study reported a fear and anxiety prevalence of 42.72% among 737 healthcare workers. A study conducted in Saudi Arabia found an anxiety prevalence of 51% among health care providers 16. A similar study in Saudi Arabia found that 68.5% of study participants had moderate to severe anxiety level in healthcare workers 14.Other recent findings in general Saudi population observed a lower 29.9% prevalence of anxiety compared to our study 17. Moreover, similar findings were found in other studies showed a prevalence of severe anxiety of 15.3% and 16% compared to our study. Our results are consistent with the severe anxiety level found among healthcare workers in Saudi Arabia 18 17. Also, a Chinese study reported a prevalence of 44.6% of anxiety among 1257 health- care providers 19.
Studies on the previous outbreak in 2017, a study reported a 52% prevalence of anxiety among HCWs working in level I trauma center in Saudi Arabia. Work-related pressures and high job responsibilities can explain anxiety in emergency situations. Other research conducted among health care professionals during the SARS outbreak indicated some causes of distress: social stigma; family members; social isolation; loss of control; self-health, family and others; changes in work; and spread of the virus20 21.
There is still no vaccine or approved therapy, which further raises fear about the thought of being infected. Healthcare staff who deal with patients continuously are at greater risk of contracting infectious diseases, creating an immense psychological toll19. Another genuine concern about HCWs is that this disease is carried to their families from their practices. As coronavirus last several hours to days on various surfaces this, along with its extended incubation time before the development of symptoms, are factors that make it especially difficult to restrict its transmission 22.
In our study, a positive correlation was found between anxiety score and female gender. A similar finding was revealed in general population where female had a higher level of fear and anxiety as compared to males 17. Similar results have been reported in the recent Jordanian study, which described women as a higher risk category for anxiety, 70.8% among healthcare providers 23.
The covid-19 has effected the people in many ways in our study majority of participants responded that this disease had caused a substantial impact on the economy, psychological life and social life. The economical impact showed that multiple businesses has been shut down with an increase in the unemployment rate. Social life is also severely affected. People are bound to stay at home. All these factors have a psychological impact on individuals mental status that leads to an increase in anxiety and fear. Early diagnosis of anxiety is of prime importance; however, studies showed that failure to identify signs of anxiety could lead to severe psychological consequences 24.
We agreed that our study has highlighted the higher levels of anxiety in HCWs that could assist decision-makers and clinicians in recognizing and providing assistance to professionals with elevated levels of anxiety. This study has some limitations. First, data was collected in a brief period of time. Second, our responses are mainly from major cities of Saudi Arabia as the response from the rural health centers still not known. Third, the response rate was low. Fourth this study did not evaluate the mental health condition of participants which might be existed before COVID-19 pandemic. Moreover, convenience sampling and cross-sectional design of study act as a barrier in making a casual conclusion. In addition, an online survey makes it difficult to generate random sampling as respondents are only those who use the internet as survey participants do not have the opportunity to ask clarifying questions. Therefore the findings of this study should be carefully interpreted and not to be generalized.
We suggest that further research on fear and anxiety must include the variables we were unable to address in this study, like socioeconomic status and mental health status of HCWs. Furthermore, SAVE-9 25rating scale should be used in future research to validate the systematic evaluation of stress and anxiety level in HCWs during COVID-19 pandemic.
In conclusion, despite having a high level of knowledge and practice, healthcare workers are in a state of fear and anxiety. Our study demonstrated that two-third of the healthcare workers had a moderate risk of fear and anxiety. However, females participants found to have elevated fear and anxiety level. In future, larger population studies are needed to confirm our findings. Our research was able to capture the impact of COVID-19 pandemic on mental health. Some relevant potential research area has also been suggested to determine the effect of COVID-19 pandemic.