• Users Online: 151
  • Print this page
  • Email this page


 
 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 85-97

The psychological impact of COVID-19 on health-care workers in African Countries: A systematic review


1 Department of Psychiatry, University of Botswana, Gaborone, Botswana, Nigeria
2 Department of Clinical Services, Federal Neuropsychiatric Hospital, Benin City, Edo State, Nigeria
3 Department of Library Services, University of Botswana, Gaborone, Botswana, Nigeria

Date of Submission04-May-2021
Date of Decision16-Jun-2021
Date of Acceptance07-Jul-2021
Date of Web Publication26-Jul-2021

Correspondence Address:
Oluyemi O Akanni
Federal Neuropsychiatric Hospital, Benin City, Edo State
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/shb.shb_32_21

Rights and Permissions
  Abstract 


In Africa, a systematic appraisal of the associated pattern of psychiatric disorders (PDs) among health-care workers (HCWs) is lacking. We, therefore, aimed to ascertain the pattern of PDs and their associated risk factors among HCWs in Africa during the Coronavirus Disease 2019 pandemic. We identified 12 studies for inclusion after searching four databases: Web of Science, PubMed, AJOL, and EBSCOhost for articles written in English from January 2020 to April 2021. Anxiety disorder with rates from 9.5% to 73.3% and depression, 12.5% to 71.9%, were the most reported PDs. Availability of protective gear and information regarding preventive measures reduced the risk of developing any PDs, while psychoactive substance use, history of chronic medical illness, low level of resilience, and low social support increased these risks. A considerable proportion of HCWs manifest various psychological problems such as their counterparts in other parts of the world. Multiple factors were also implicated as risk, albeit associations were not consistently established across the studies. There is a need to increase research capacity tailored to the HCW population's needs in the continent.

Keywords: African countries, coronavirus disease 2019 pandemic, health-care workers, psychiatry, review


How to cite this article:
Olashore AA, Akanni OO, Fela-Thomas AL, Khutsafalo K. The psychological impact of COVID-19 on health-care workers in African Countries: A systematic review. Asian J Soc Health Behav 2021;4:85-97

How to cite this URL:
Olashore AA, Akanni OO, Fela-Thomas AL, Khutsafalo K. The psychological impact of COVID-19 on health-care workers in African Countries: A systematic review. Asian J Soc Health Behav [serial online] 2021 [cited 2021 Sep 21];4:85-97. Available from: http://www.healthandbehavior.com/text.asp?2021/4/3/85/322292




  Introduction Top


Coronavirus Disease 2019 (COVID-19) is caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-COV 2), which was first detected in 2019 at a wet market in Wuhan, China.[1]

Early 2020, the WHO declared the COVID-19 a global pandemic as it spread across several continents, causing a high mortality rate in most countries affected.[2] Africa confirmed its first case in Egypt on February 14, 2020.[3] As of June 30, 2021, 47 countries in Africa were affected, with about 3,962,827 confirmed cases and 94,634 reported deaths.[4] Nevertheless, Africa seems to be the least hit continent than other continents.[5],[6]

The transmission route is believed to be through air droplets and respiratory secretions produced when an infected person speaks sneezes or coughs.[7] Generally, most people infected will produce mild or no symptoms, but in some people (elderly and those with comorbidities), it may provoke severe symptoms, which may be fatal.[8]

The health-care workers (HCWs) are usually the first point of contact during epidemics and are susceptible to infectious diseases during outbreaks. In Africa, where inadequate resources and low human resources hamper the health-care system, there may be concerns about the personal protection of the HCWs against this infection, whose prognosis is rife with uncertainties.[9] HCWs may also be required to work longer hours to meet up with an ongoing pandemic's demands.[10] Furthermore, there may be anxiety and concerns about contracting the virus and transmitting it to their loved ones. These may precipitate mental health issues in this group of workers and invariably impact service delivery.[10],[11] For instance, a cross-sectional web survey conducted among some selected HCWs in New York during the peak of COVID-19 inpatient admission revealed that 57% of the respondents had acute stress, 48% depression, and 33% anxiety.[12] Other risk factors associated with developing mental health issues among HCWs during this pandemic have also been reported.[13],[14] Protective factors mitigating the risk of developing mental health problems in HCWs during the pandemic include receiving clear communications and directives about precautionary measures from their organization, provision of early support, adequate compensation from their organizations, provision of mental health services to the HCWs, especially those with severe psychological distress, training, human resources allocation, and adequate equipment.[11],[15]

There is a dearth of data on COVID-19-related psychological effects on HCWs in Africa, with most reviews on this subject being conducted in other continents.[15],[16] This review intends to bridge this gap, thereby informing the government's decision on policies to put in place to mitigate the psychological effects of the disease on the mental health of the HCWs during this ongoing pandemic. This review's objectives were to ascertain the pattern of psychiatric disorders (PDs) among HCWs in Africa during COVID-19 and to determine the common risk factors for developing PDs among these workers during this pandemic.


  Methods Top


The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines[17] were used to guide the design and reporting of this review. Before the onset of this project, a protocol was written, registered, and published on PROSPERO: the registration number is CRD42021265093.

Search strategy

This review involved a rigorous systematic search of the peer-reviewed literature. The following electronic databases were searched: The Web of Science, PubMed, AJOL, and EBSCO (Academic Search Complete, CINAHL with Full Text, MEDLINE, MEDLINE with Full Text, MLA International Bibliography, and Open Dissertations) for the peer review published articles from Africa. In addition to these, reference lists of the articles were hand-searched for additional relevant studies (snowballing). The keywords include synonyms of PDs, COVID-19, HCWs, the list of all African countries, and their combinations.

The electronic databases were searched for titles or abstracts containing these terms in all published articles after December 31, 2019, to March 14, 2021. The search was limited to studies published in English. The review included all quantitative studies such as cross-sectional and longitudinal observational.

A HCW was defined as anyone who delivers care and services to the sick and ailing directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers.[18] The PD was defined by DSM-5 or ICD-10 criteria including substance use disorders as well as symptoms of disorders that may not meet diagnostic thresholds (e. g., depressive symptoms), psychological distress, insomnia, and suicide attempt. COVID-19 on the other hand, is an illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV).

All studies meeting the following inclusion criteria were selected for the review:

  1. Studies that measure one or more PDs or measures of symptoms of mental disorder
  2. Studies limited to the current COVID-19 pandemic
  3. Studies reporting data on HCWs located in African countries.


Studies were excluded based on the following criteria

  1. Publications reporting duplicate data from the same population: In such cases, the report with the larger sample size was preferentially included
  2. Studies that include mixed HCW and general populations
  3. Qualitative studies: case reports, conference proceedings, dissertations, or any other form of unpublished data.


Selection procedure

One of the researchers, a medical librarian (KK), searched for articles relevant to the keywords using their titles and abstracts. The selection criteria were applied to the titles and abstracts independently by two researchers (AF and OA) using the same databases. The complete reports for all related articles were obtained and screened to decide whether they met the inclusion criteria. Wherever there was any uncertainty or disagreement, the researchers resolved through discussions and consensus. A flow diagram was used to depict how the systematic review's final studies were arrived at [Figure 1]. In accord with the PRISMA statement, the following phases of selection were used as a guide: identification phase, a screening phase, eligibility phase, and inclusion phase [Figure 1].
Figure 1: Selection flow diagram

Click here to view


Data extraction (selection and coding) and strategy for data synthesis

Study data were extracted onto a structured, customized data-extraction sheet, and this includes authors, country, aims, study characteristics (including sociodemographic/clinical variables, measures, study design, and sampling strategy), and outcome (mental disorder or psychiatric).

Quality assessment

Quality assessment was done using a modified form of New Castle Ottawa Checklist and articles were selected if:

  1. Data selection process and sample size were justified
  2. At least, even if nonvalidated measurement tool, the tool is available or described
  3. Outcomes were specified and defined
  4. The statistical test used to analyze the data is clearly described and appropriate, and the measurement of the association is presented.


The criteria used in assessment are shown in [Table 1].
Table 1: New Castle Ottawa Quality Assessment Checklist

Click here to view


Data synthesis

A narrative synthesis was conducted to describe the design, implementation, and findings of the studies. Where a nonstandardized measure/instrument was used for the diagnosis of PD, it was stated in the table [Table 2].
Table 2: Characteristics of the selected studies

Click here to view



  Results Top


We identified 233 records through database searching. After removing duplicates and screening for eligibility, we ended up with 12 published studies for analysis.

Characteristics of included studies

Studies included were conducted between March 2020[22] and September 2020.[27] Almost half of the studies included were conducted in Ethiopia.[20],[24],[25],[29]

The studies included HCWs from various settings such as health-care referral centers,[27] general medical facilities,[19] and community care centers.[23] All the studies included participants from various health-care professionals such as doctors, nurses, and pharmacists, except three studies that included only a single profession: nurses[24],[27] and radiographers.[22]

Except for the study conducted in South Sudan by Zhang et al.,[21] which was longitudinal, all the studies were cross sectional. The instruments used varied and include self-report/interviewers designed tool,[22],[24] the Patient Health Questionnaire-9 for depression, and the 7-item Generalized Anxiety Disorder (GAD-7),[19],[20],[21],[30] and the Depression, Anxiety, and Stress Scale-21 Items (DASS-21).[27]

Prevalence of psychological disorders among health-care worker

Outcome measures vary from general psychological distress and stress[24],[27],[29] to specific PDs such as depression, anxiety, and insomnia.[19],[23],[26],[27],[30]

The prevalence of anxiety disorder ranges from 9.5% to 73.3% using GAD-7, HAD, and DASS-21.[19],[20],[23],[26],[27],[28] Depression was reported to range from as low as 12.5% to as high as 71.9%, using the same tools.[19],[23],[26],[27],[30] Only one study measured insomnia among HCW and found a rate of 77% using the Insomnia Severity Index. Stress was found to be 20% by Mekonen et al.[27] and 75.4% by Akudjedu et al.[22] However, while the former used a standardized instrument (DASS), the latter used an investigator-designed self-report tool. According to two Ethiopia studies, the rates of psychological distress were 42%[29] and 83.5%.[24]

Factors that are associated with psychiatric disorders during coronavirus disease 2019

Anxiety was found to increase among HCWs who had symptoms of COVID-19.[19] Inability to cope with stress (aPOR = 2.74, 95% confidence interval [CI] = 1.633, 4.606) and having COVID-19-related worry were found to increase the risk of developing anxiety.[20] In the same, vein, anxiety, and increased stress score were twice as common in those who had contact with confirmed cases, were significantly more common among those who were afraid of contamination or infecting their families.[20],[26],[27] Those who do a night shift and those who reported having chronic disease had increased stress scores in one of the studies.[27]

The increasing number of weeks on COVID-19 frontline duty,[19] working in the general medical center,[23] history of mental disorder as well as having a chronic medical disease[27] increased the risk of depression. Depression and insomnia were significantly more common among women,[19],[23] while depression was significantly more common among nurses,[19] insomnia was less common[23] among this group compared to others in the medical team.

HCWs who were not given adequate information, training, or guideline regarding COVID-19 prevention measures reported an increase in the risk of PDs such as depression,[27] stress,[27] and anxiety[20] among HCWs.

Psychological distress was significantly more common among nurses and pharmacists.[29] The use of a psychoactive substance, having a history of chronic medical illness, low level of resilience, and low social support increases the risk of developing psychosocial distress.[29]

Factors that are protective against psychiatric disorders during coronavirus disease 2019

Sagaon-Teyssier et al.[23] reported that in Mali, the availability of face masks or other protective gears reduce the risk of developing depression by 51% (IRR: 0.49, 95% CI [0.34–0.70]), insomnia by 43% (IRR: 0.57, 95% CI [0.38–0.86]), and anxiety by 49% (IRR: 0.38, 95%CI [0.21–0.67]). Conversely, Debes et al.[30] explored the association between depression and PPE availability or lockdown in Ethiopia, Tanzania, Nigeria, Egypt, Uganda, and Sudan and found no association.


  Discussion Top


This review focused on establishing the psychological impact of COVID-19 on HCWs in African countries. A total of 12 studies were identified as at the time of writing this report, which is more than a year after the first case was identified in the continent. This number is vastly lower than the hundreds of studies reported from developed countries since the beginning of the pandemic. The little data in Africa are not due to researchers' deficiency in the continent but because of the lack of support from the governments. The downside is that local data do not drive policies instituted in African countries but heavily rely on outside information, which often does not consider the peculiarity of the culture and may at times not apply to the setting. Moreover, the few research work undertaken are self-funded, and the quality of such work may not meet international standards. Therefore, there is a need for the government to give priority to research in the region.

This systematic review showed that HCWs manifested a range of psychological problem during the COVID-19 pandemic, from common PDs such as depression, anxiety, and insomnia[19],[23],[26],[30] to general psychological distress/stress.[24],[27],[29] This report pattern is consistent with similar systematic reviews done in other parts of the world, in which anxiety/depression are the most common psychological disorders reported and followed by others such as general distress, stress, and insomnia.[31] This is also similar to the pattern recorded in the general population during an epidemic,[32] though a higher prevalence of PDs is seen among HCWs when compared with the general populace.[33]

There are several reasons why disorders such as depression and anxiety may be on the rise in times like this. The outbreak is characterized by uncertainty and fear of the disease and infectiousness,[34],[35] loss of loved ones, and degrading of socioeconomic status of people, such as job losses, financial difficulties, and social isolation.[36] This is apart from conditions related to or specific to health professionals' nature of work in Africa such as high level of stress, job dissatisfaction as a result of poor remuneration, increase job demand, long working hour, and pitiable work environment.[37] All these increase stress levels, which explains the higher prevalence of anxiety and depression compared to the general population.

We noticed that less commonly occurring disorders were omitted or least likely inquired. For instance, only one of the studies reported insomnia[23] which is well reported in other studies and reviews outside of Africa.[33],[38],[39],[40] None in this review enquired for suicide, somatization, or stress-related disorders such as posttraumatic stress disorder, which have been reported in others.[41],[42],[43],[44],[45] It may also be informative to know that disorders such as alcohol/substance use and adjustment disorder are rarely investigated in most studies. Adjustment disorder, though a mild mental illness, is not unexpected in a pandemic period because measures taken to curtail viral spread have led to many social changes that will require adjustment.[36] While it is understandable why research light will be focused on commonly occurring conditions, researchers must be careful not to neglect these other cases, which merit investigation in their right because of their disabling consequences. Researchers in Africa and other parts of the world should be aware of this proposition.

We attempted to synthesize all the etiological factors in the development of psychological problems and discovered a substantial range of risk factors. Moreover, among these varying associated factors, none appeared to be consistent across the studies. Varieties of risk factors established for anxiety, though not reproducible, were HCWs who had symptoms suggestive of COVID-19,[19] inability to cope with stress, and having COVID-19-related worry.[20] However, only contact with confirmed cases and fear of contamination or infecting their families were replicated in three studies as anxiety correlates.[20],[26],[27] Furthermore, those who do a night shift and those who reported having a chronic disease[27] had greater anxiety, while the increasing number of weeks on COVID-19 frontline duty,[19] working in the general medical center,[23] history of mental disorder as well as having a chronic medical disease[27] increased the risk of depression. Besides, the female gender and nursing profession were significantly important in the development of depression.[19] For distress, they were nurses and pharmacists profession,[29] the use of a psychoactive substance, having a history of chronic medical illness, low level of resilience, and low social support.[29]

Similarly, though two, the studies that investigated protective factors did not arrive at a consensus but a somewhat conflicting position. For instance, the availability of PPE was found to protect against depression by Sagaon-Teyssier et al.,[23] while the Debes et al.[30] study failed to replicate this. The divergent or contradictory observation may be because of diverse methods adopted, different materials used for measuring outcomes, and sometimes the use of unstandardized scales. However, because the number of studies gathered is few, it may be premature to conclude on the disagreement with the studies' outcome. More studies are required for stronger evidence and a better decision to be reached.

It is also significant to note that most of the studies mirror those from the USA, Europe, and Asian countries. Culturally determined disorders, which are often depression or anxiety related, were omitted. Brain fag syndrome, a typical example of a culture-bound syndrome, is described not only among African students but also as “brain workers,” and others were missing.[46],[47],[48] Debatable syndrome like this, which is believed to be anxiety parallel, is thought to be going into extinction because they are not sought for.[49],[50] Furthermore, coping mechanism such as religion/spirituality which African popularly applies for the protection against mental illness[51],[52] was not investigated. Indigenous investigators should measure outcomes and factors that may be more relevant within the African context rather than copying research from abroad.

Limitations

There are key limitations to the review. The number of studies available is relatively low, considering how long the pandemic has lasted. This makes it difficult to arrive at a generalizable conclusion. More studies are encouraged to come from the continent to fill in gaps pertinent to knowledge in the region. For example, it is uncertain why the higher prevalence of anxiety previously and consistently reported among nurses, when compared to other hospital workers in other climes,[40],[53] was not found in most African studies.[19],[23],[26]

Moreover, the included studies varied widely in their methodologies and diversity of scope, hence making the synthesis of the findings challenging. Furthermore, some of the studies had methodologies and results with inadequate information and fell short of the standard. Authors from the continent can adopt standard guidelines to improve their work presentation, which will make data gathering for future systematic review more manageable.

Nevertheless, the study has a strength. To our knowledge, this is the first systematic review to examine the pattern of psychological disorders, their risk, and protective factors as experienced by HCW in Africa during the COVID-19 outbreak. It thus becomes a reference point for other work to build on.


  Conclusion Top


The 12 studies on psychological impact among African HCWs during the COVID-19 pandemic have shown that there is a considerable proportion of HCWs who manifest various psychological problems of mood and stress similar to counterparts in other parts of the world. The evaluation revealed multiple factors implicated as risks; however, there was no match in the association of these sociodemographics and other COVID-19-related factors across the studies. We recommended funding and support to researchers to improve both the quantity and quality of research work and suggested a need for research to be tailored to the HCW population's needs in the continent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: An overview. J Chin Med Assoc 2020;83:217-20.  Back to cited text no. 1
    
2.
Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – An update on the status. Mil Med Res 2020;7:11.  Back to cited text no. 2
    
3.
Lone SA, Ahmad A. COVID-19 pandemic – An African perspective. Emerg Microbes Infect 2020;9:1300-8.  Back to cited text no. 3
    
4.
WHO. Coronavirus Disease (COVID-19): Situation Report; 2021. Available from: https://www.afro.who.int/health-topics/coronavirus-covid-19. [Last accessed on 2021 Jul 02].  Back to cited text no. 4
    
5.
Dyer O. Covid-19: Africa records over 10 000 cases as lockdowns take hold. BMJ 2020;369:m1439.  Back to cited text no. 5
    
6.
Nachega J, Seydi M, Zumla A. The late arrival of coronavirus disease 2019 (COVID-19) in Africa: Mitigating pan-continental spread. Clin Infect Dis 2020;71:875-8.  Back to cited text no. 6
    
7.
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433.  Back to cited text no. 7
    
8.
Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr 2020;87:1-6.  Back to cited text no. 8
    
9.
Chersich MF, Gray G, Fairlie L, Eichbaum Q, Mayhew S, Allwood B, et al. COVID-19 in Africa: Care and protection for frontline healthcare workers. Global Health 2020;16:46.  Back to cited text no. 9
    
10.
Pfefferbaum B, North CS. Mental health and the COVID-19 pandemic. N Engl J Med 2020;383:510-2.  Back to cited text no. 10
    
11.
Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020;368:m1211.  Back to cited text no. 11
    
12.
Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2020;66:1-8.  Back to cited text no. 12
    
13.
Greenberg N. Mental health of health-care workers in the COVID-19 era. Nat Rev Nephrol 2020;16:425-6.  Back to cited text no. 13
    
14.
Di Tella M, Romeo A, Benfante A, Castelli L. Mental health of healthcare workers during the COVID-19 pandemic in Italy. J Eval Clin Pract 2020;26:1583-7.  Back to cited text no. 14
    
15.
De Brier N, Stroobants S, Vandekerckhove P, De Buck E. Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS and COVID-19): A rapid systematic review. PLoS One 2020;15:e0244052.  Back to cited text no. 15
    
16.
Carmassi C, Foghi C, Dell'Oste V, Cordone A, Bertelloni CA, Bui E, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Res 2020;292:113312.  Back to cited text no. 16
    
17.
Moher D, Liberati A, Tetzlaff J, Altman DG; Group P. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6:e1000097.  Back to cited text no. 17
    
18.
Joseph B, Joseph M. The health of the healthcare workers. Indian J Occup Environ Med 2016;20:71-2.  Back to cited text no. 18
[PUBMED]  [Full text]  
19.
Erinoso O, Adejumo O, Fashina A, Falana A, Amure MT, Okediran OJ, et al. Effect of COVID-19 on mental health of frontline health workers in Nigeria: A preliminary cross-sectional study. J Psychosom Res 2020;139:110288.  Back to cited text no. 19
    
20.
Teshome A, Glagn M, Shegaze M, Tekabe B, Getie A, Assefa G, et al. Generalized anxiety disorder and its associated factors among health care workers fighting COVID-19 in Southern Ethiopia. Psychol Res Behav Manag 2020;13:907-17.  Back to cited text no. 20
    
21.
Zhang Y, Xiang D, Alejok N. Coping with COVID-19 in United Nations peacekeeping field hospitals: increased workload and mental stress for military healthcare providers. BMJ Mil Health 2020;1-5. doi: 10.1136/bmjmilitary-2020-00164.  Back to cited text no. 21
    
22.
Akudjedu TN, Botwe BO, Wuni AR, Mishio NA. Impact of the COVID-19 pandemic on clinical radiography practice in low resource settings: The Ghanaian radiographers' perspective. Radiography (Lond) 2021;27:443-52.  Back to cited text no. 22
    
23.
Sagaon-Teyssier L, Kamissoko A, Yattassaye A, Diallo F, Rojas Castro D, Delabre R, et al. Assessment of mental health outcomes and associated factors among workers in community-based HIV care centers in the early stage of the COVID-19 outbreak in Mali. Health Policy Open 2020;1:100017.  Back to cited text no. 23
    
24.
Tadesse DB, Gebrewahd GT, Demoz GT. Knowledge, attitude, practice and psychological response toward COVID-19 among nurses during the COVID-19 outbreak in northern Ethiopia, 2020. New Microbes New Infect 2020;38:100787.  Back to cited text no. 24
    
25.
Mulu GB, Kebede WM, Worku SA, Mittiku YM, Ayelign B. Preparedness and responses of healthcare providers to combat the spread of COVID-19 among North Shewa Zone Hospitals, Amhara, Ethiopia, 2020. Infect Drug Resist 2020;13:3171-8.  Back to cited text no. 25
    
26.
Nguépy Keubo FR, Mboua PC, Djifack Tadongfack T, Fokouong Tchoffo E, Tasson Tatang C, Ide Zeuna J, et al. Psychological distress among health care professionals of the three COVID-19 most affected Regions in Cameroon: Prevalence and associated factors. Ann Méd Psychol 2021;179:141-6. doi: 10.1016/j.amp.2020.08.012.  Back to cited text no. 26
    
27.
Mekonen E, Shetie B, Muluneh N. The psychological impact of COVID-19 outbreak on nurses working in the northwest of amhara regional state referral hospitals, northwest Ethiopia. Psychol Res Behav Manag 2020;13:1353-64.  Back to cited text no. 27
    
28.
Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: A multicentre, cross-sectional study. SAGE Open Med 2021;9:1-10.  Back to cited text no. 28
    
29.
Tsehay M, Belete A, Necho M. Factors associated with psychological distress and brief resilient coping level during the COVID-19 pandemic among health-care professionals in Dessie, Ethiopia. Psychol Res Behav Manag 2020;13:1213-21.  Back to cited text no. 29
    
30.
Debes JD, Quadri NS, Sultan A, Yousif M, Ali SI, Kayandabila J, et al. Risk of healthcare worker burnout in Africa during the COVID-19 Pandemic. Ann Glob Health 2021;87:5.  Back to cited text no. 30
    
31.
Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: A cross-sectional survey. Epidemiol Infect 2020;148:e98.  Back to cited text no. 31
    
32.
Ji D, Ji YJ, Duan XZ, Li WG, Sun ZQ, Song XA, et al. Prevalence of psychological symptoms among Ebola survivors and healthcare workers during the 2014-2015 Ebola outbreak in Sierra Leone: A cross-sectional study. Oncotarget 2017;8:12784-91.  Back to cited text no. 32
    
33.
Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res 2020;293:113382.  Back to cited text no. 33
    
34.
Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res 2020;288:112936.  Back to cited text no. 34
    
35.
Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, et al. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel coronavirus disease outbreak. Front Psychiatry 2020;11:306.  Back to cited text no. 35
    
36.
Olashore AA, Akanni OO, Bojosi K, Garechaba G. Case series of suicide attempts during the coronavirus disease (COVID-19) lockdown. Int J Ment Health Psychiatry 2020;6:180.  Back to cited text no. 36
    
37.
Akanni OO, Osundina AF, Agbonile IO, Olotu SO, Ayilaraa OO, Akhigbeb KO. Self-reported psychological distress and its relationship with religiousness of Nigerian physicians: A multicenter study. Internet J Med Update 2019;14(2):6-11. doi: 10.4314/ijmu.v14i2.2.  Back to cited text no. 37
    
38.
da Silva FC, Neto ML. Psychological effects caused by the COVID-19 pandemic in health professionals: A systematic review with meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2021;104:110062.  Back to cited text no. 38
    
39.
Muller AE, Hafstad EV, Himmels JP, Smedslund G, Flottorp S, Stensland SØ, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Res 2020;293:113441.  Back to cited text no. 39
    
40.
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901-7.  Back to cited text no. 40
    
41.
Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom 2020;89:242-50.  Back to cited text no. 41
    
42.
Blakey SM, Kirby AC, McClure KE, Elbogen EB, Beckham JC, Watkins LL, et al. Posttraumatic safety behaviors: Characteristics and associations with symptom severity in two samples. Traumatology 2020;26:74.  Back to cited text no. 42
    
43.
Park JS, Lee EH, Park NR, Choi YH. Mental health of nurses working at a government-designated hospital during a MERS-CoV outbreak: A cross-sectional study. Arch Psychiatr Nurs 2018;32:2-6.  Back to cited text no. 43
    
44.
Jiang HJ, Nan J, Lv ZY, Yang J. Psychological impacts of the COVID-19 epidemic on Chinese people: Exposure, post-traumatic stress symptom, and emotion regulation. Asian Pac J Trop Med 2020;13:252.  Back to cited text no. 44
  [Full text]  
45.
Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med 2021;51:1052-3.  Back to cited text no. 45
    
46.
Prince R. The “brain fag” syndrome in Nigerian students. J Ment Sci 1960;106:559-70.  Back to cited text no. 46
    
47.
Essien EA, Okafor CJ, Okegbe J, Udofia O. Pattern and predictors of Brain Fag syndrome among senior secondary school students in Calabar, Nigeria. Niger Postgrad Med J 2017;24:137-42.  Back to cited text no. 47
[PUBMED]  [Full text]  
48.
Morakinyo O, Peltzer K. 'Brain Fag' symptoms in apprentices in Nigeria. Psychopathology 2002;35:362-6.  Back to cited text no. 48
    
49.
Ayonrinde OA, Obuaya C, Adeyemi SO. Brain fag syndrome: A culture-bound syndrome that may be approaching extinction. BJPsych Bull 2015;39:156-61.  Back to cited text no. 49
    
50.
Aina OF, Morakinyo O. Culture-bound syndromes and the neglect of cultural factors in psychopathologies among Africans. Afr J Psychiatry (Johannesbg) 2011;14:278-85.  Back to cited text no. 50
    
51.
Akanni OO, Olashore AA, Oderinde KO. Relationship between spirituality and anxiety during the COVID-19 pandemic: A survey of the staff of two Nigerian tertiary hospitals. Ment Health Relig Cult 2012. [Article in Press].   Back to cited text no. 51
    
52.
Akanni OO, Otakpor A. Psychological distress and resilience: A study of prevalence and association among school-attending adolescents in Benin-City. Sri Lanka J Psychiatry 2016;7:18-22.  Back to cited text no. 52
    
53.
Saleem Z, Majeed MM, Rafique S, Siqqiqui Z, Ghandhi D, Tariq H, et al. COVID-19 pandemic fear and anxiety among healthcare professionals in Pakistan. Researchsquare 2020. [Preprint].  Back to cited text no. 53
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 Factors associated with violence against women following the COVID-19 lockdown in France: Results from a prospective online survey
William Peraud,Bruno Quintard,Aymery Constant,Amir H. Pakpour
PLOS ONE. 2021; 16(9): e0257193
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed565    
    Printed20    
    Emailed0    
    PDF Downloaded116    
    Comments [Add]    
    Cited by others 1    

Recommend this journal