The rapid spread of coronavirus disease (COVID-19) has led to general psychosis among the population in Ivory Coast. The medical profession, on the front line of the treatment, was in distress, given the risk of exposure to the patient. It is in this context that this study has set itself the objective of studying anxiety among caregivers involved in the management of people with COVID-19. This is a cross-sectional, descriptive and analytical study that included a sample of 50 stakeholders. It took place from July to September 2020 at the Treatment Center of the Village of Information Technologies and Biotechnology in Grand-Bassam (VITIB) and the Infectious Diseases Treatment Center (CTMI) of the University Hospital (CHU) of Cocody. The results indicate that caregivers were male in 52% of cases with an average age of 36 years. These are: doctors, nurses and caregivers respectively in the proportions of 18%, 42% and 40% with more than half (58%) who had more than 5 years of seniority. A proportion of 34% of caregivers felt they were insufficiently protected. The Hamilton Scale assessment of anxiety showed that 14% had mild anxiety, 6% moderate anxiety and 2% severe anxiety. There was no link between the degree of anxiety and professional seniority but also between the degree of anxiety and the marital situation. This work has therefore made it possible to see that anxiety is a real problem for caregivers dedicated to the management of COVID-19 patients.
Corona Virus Disease (Covid-19) is an infectious disease of viral origin, due to severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2). It most often manifests as mild influenza symptoms, but severe variants, in the form of respiratory distress, are not uncommon in individuals with risk factors [
Thus in Ivory Coast, several actions were undertaken by the government: the establishment of a crisis committee, awareness and dissemination of preventive measures, the development of an emergency response plan, systematic detection of suspected cases of travellers from countries affected by the pandemic, quarantine or containment of suspected and confirmed cases and management of confirmed cases [
Moreover, the rapid spread of the disease, the lack of information on the infection and the lack of specific treatment available have led to psychosis in the general population but especially in hospitals. It is in this context that this research work was initiated in order to assess the psychological state of caregivers involved in the treatment of people with dementia. The study is part of a quantitative and qualitative approach.
This was a cross-sectional descriptive and analytical study that took place at the two sites for the management of people with dementia. This is a part of the VITIB in Grand-Bassam, clerk to welcome asymptomatic or paucisymptomatic patients and on the other hand the CTMI at the Cocody University Hospital equipped with a resuscitation unit with a capacity of seven patients and a medical hospitalization unit with a capacity of twenty patients.
The nursing staff consisted respectively of 06 doctors, 17 nurses and 12 orderlies for VITIB and 45 doctors, 29 nurses and 31 orderlies for CTMI.
Included in our study were doctors, nurses and orderlies from these centres who were in contact with patients and who gave their consent to participate in the survey.
On the basis of a voluntary sample, we retained 50 caregivers out of 140 (35.71%) including 09 doctors, 21 nurses (era) and 20 caregivers.
The collection of data that lasted 3 months (from July to September 2020), was done on individual survey sheets filled in by the caregivers themselves. The parameters assessed were related to the bio-sociodemographic profile (age, sex, marital status, number of children, seniority), roles in management and level of anxiety (assessed by the Hamilton Scale).
The Hamilton Anxiety Rating Scale (HARS; Hamilton 1959) is an instrument for detecting and measuring the severity of perceived anxiety symptoms, evaluated by the clinician in 14 points or items rated from 0 to 4 depending on intensity. It was originally designed to assess treatment outcomes by clinicians. His interpretation gives us 4 situations namely score 12, anxiety called “normal”; score between 12 and 20 mild anxiety; score between 20 and 25, moderate anxiety; score > 25, severe to severe anxiety [
The survey sheet that we developed was administered to caregivers after a pre-test of 5 caregivers with the same characteristics as those in our study sample. The collection instrument was refined before the actual survey was started.
The data collected was captured and analyzed using computer hardware including SPSS 18, Excel 16 and Word 16. The results were presented in tabular form. For the analysis, it was a mixed analysis of qualitative and qualitative variables. The test used is the Fisher exact test which is an exact statistical test used for contingency table analysis. This test is generally used with low numbers (n < 5) but is valid for all sample sizes. It owes its name to its inventor, Ronald Fisher. It is a test qualified as exact because probabilities can be calculated exactly rather than relying on an approximation that becomes correct only asymptotically as for the test of Khi 2 used in contingency tables.
The sample size was composed of 50 caregivers including 09 doctors, 21 nurses (era) and 20 caregivers.
The 26 - 35 and 36 - 50 age groups were the most represented in 44% of cases each with an average age of caregivers of 36 years. Male subjects predominated in 52% with a sex ratio of 1.08. Our respondents were mostly single (40%). Among caregivers, nurses and nursing assistants were the most represented corporations in our study respectively in 42% and 40%. The majority of participants (58%) had a seniority professional between 1 and 5 years (
The Hamilton-wide anxiety assessment indicated that 20% of practitioners had mild, moderate or severe anxiety (
| Parameters | Effective | Percentage |
|---|---|---|
| Age (years) | (n = 50) | (%) |
| 18 - 25 | 05 | 10 |
| 26 - 35 | 22 | 44 |
| 36 - 50 | 22 | 44 |
| 50 and more | 01 | 02 |
| Sex | (n = 50) | (%) |
| Masculine | 26 | 52 |
| Female | 24 | 48 |
| Marital status | (n = 50) | (%) |
| Single | 20 | 40 |
| Married | 18 | 36 |
| Common-law | 12 | 24 |
| Corporation | (n = 50) | (%) |
| Doctors | 09 | 18 |
| Nurses | 21 | 42 |
| Orderlies | 20 | 40 |
| Professional seniority | (n = 50) | (%) |
| 1 - 5 | 29 | 58 |
| 6 - 10 | 13 | 26 |
| 11 - 15 | 03 | 06 |
| 16 - 20 | 02 | 04 |
| 21 and more | 03 | 06 |
| Echelle HAMILTON | Effectifve (n = 50) | % |
|---|---|---|
| “Normal” anxiety | 40 | 80 |
| Mild anxiety | 05 | 10 |
| Moderate anxiety | 04 | 08 |
| Severe to severe anxiety | 01 | 02 |
| Total | 50 | 100 |
| Degree of anxiety Professional Seniority | “normale” anxiety | Severe to severe anxiety | Mild anxiety | Moderate anxiety | Total |
|---|---|---|---|---|---|
| 1 - 5 | 25 | 01 | 01 | 02 | 29 |
| 11 - 15 | 02 | 00 | 00 | 01 | 03 |
| 16 - 20 | 01 | 00 | 00 | 01 | 02 |
| 21 and more | 03 | 00 | 00 | 00 | 03 |
| 6 - 10 | 09 | 00 | 04 | 00 | 13 |
| Total | 40 | 01 | 05 | 04 | 50 |
| Fisher test, dependence is not significant. p = 0.1077 | |||||
| Marital status Anxiety | Single | Common-law | Married | Total |
|---|---|---|---|---|
| “Normal” anxiety | 18 (90%) | 9 (75%) | 13 72% | 40 |
| Mild anxiety | 1 (5%) | 2 (17%) | 2 (11%) | 5 |
| Moderate anxiety | 1 (5%) | 1 (8%) | 2 (11%) | 4 |
| Severe to severe anxiety | 0 (0%) | 0 (0%) | 1 (6%) | 1 |
| Total | 20 | 12 | 18 | 50 |
| Fisher test, p = 0.753 | ||||
The intersection of anxiety with seniority is not significant. There is therefore no link between anxiety and professional seniority (
The increase in the degree of anxiety with the marital situation is therefore not significant no link between the anxiety and the marital situation (
The ages of the participants were largely (44%) between 26 and 50 years with an average age of 36 years. This shows that the caregivers of these treatment centers are young adults and adults. This result is almost superimposed on that of Mboua et al. (2020) [
Regarding gender, the majority of caregivers (52%) were male. Mboua et al. (2020) [
The marital situation of our respondents was dominated by unmarried (40% single and 24% common-law) followed by married (36%). Our results differ from those of Zhang W. et al. (2020) [
The professional profile of caregivers in our study was dominated by nurses and caregivers respectively in 42% and 40%. Our results corroborated those of Lai J et al. (2019) [
At the level of professional seniority, the majority of caregivers (58%) had a professional experience of up to 5 years while Juhong Zhu (2020) [
The Hamilton Scale Anxiety Assessment showed that 20% had anxiety with 10% mild anxiety, 8% moderate anxiety and 2% severe anxiety. The study by Lai et al. (2019) [
The intersection between seniority and anxiety showed that there was no link between anxiety and occupation. This result differs from those of Halouani et al. (2018) [
The intersection of anxiety and marital status showed no link between anxiety and marital status. No association between Anxiety and marital status was found in the study of Kandouci et al. [
Some limitations were noted in our study. The fact that this is a cross-sectional study is already a limitation. For Kandouci et al. [
Another limitation of our study is the small sample size. Indeed, 50 caregivers have agreed to participate in the survey of a total of 140 caregivers in the two treatment sites for people with Covid-19 disease. Despite the guarantee of anonymity and confidentiality of the data, 90 caregivers refused to participate in the survey. This refusal could be explained by the fact that the caregivers did not want to be assessed and were afraid of being diagnosed as anxious and therefore fragile. Also in black Africa in the popular perception, the caregiver is supposed to be protected from any disease and hold the remedy if necessary. Our results could not be generalized to all caregivers involved in the management of patients with Covcid-19.
We can also point out bias, because we do not have the means to attest to the veracity of certain information collected during our investigation.
This study conducted on caregivers working in treatment centers for people with covid-19 has highlighted that anxiety is a psychological and physiological state characterized by somatic components, cognitive and behavioral emotions represent an occupational risk in these environments. The prevalence of anxiety in this population was 20%. In addition, the study related the length of professional service and the degree of anxiety without significant link. However, there is a need to put in place psychological support for caregivers and ensure their mental well-being in order to ensure the sustainability of these health services.
The authors declare no conflicts of interest regarding the publication of this paper.
Ahounou, E.I., N’Guessan, K.R., Aka, R.A., Gonce, D.A., Gahy, G.E. and Yeo-Tenena, Y.J.-M. (2023) Assessment of Anxiety among Caregivers at the Covid-19 Treatment Centers in Grand- Bassam and Cocody-Abidjan from July to September 2020. Open Journal of Psychiatry, 13, 410-420. https://doi.org/10.4236/ojpsych.2023.135030
IDENTIFIER No. Form No. /_ /_ /_ /
I. Socio-Professional Characteristics1. Age (years): /_ / 1) 18 - 25 2) 26 - 35 3) 36 - 50 4) 50 and more
2. Sex: / _ / 1) Female 2) Masculine
3. Marital status: /_ / 1) Single 2) Common-law 3) Married 4) Divorced 5) Widowed
4. Corporation: /_ / 1) Doctor 2) Nurse 3) Midwife 4) Orderlies
5. Professional Seniority (years): /_ / 1) 1 - 5 2) 6 - 10 3) 11 - 15 4) 16 - 20 5) 20 and more
II. Assessment of Anxiety Using the Hamilton ScaleHamilton Anxiety Rating Scale (HAM-A)
Reference: Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32: 50-55.
Rating Clinician-rated
Administration time 10-15 minutes
Main purpose To assess the severity of symptoms of anxiety
Population Adults, adolescents and children
Commentary
The HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms, and is still widely used today in both clinical and research settings. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Although the HAM-A remains widely used as an outcome measure in clinical trials, it has been criticized for its sometimes poor ability to discriminate between anxiolytic and antidepressant effects, and somatic anxiety versus somatic side effects. The HAM-A does not provide any standardized probe questions. Despite this, the reported levels of inter-rater reliability for the scale appear to be acceptable.
Scoring
Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0 - 56, where <17 indicates mild severity, 18 - 24 mild to moderate severity and 25 - 30 moderate to severe.
Versions
The scale has been translated into: Cantonese for China, French and Spanish. An IVR version of the scale is avail- able from Healthcare Technology Systems.
Additional references
Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord l988; 14(1): 61-68.
Borkovec T and Costello E. Efficacy of applied relaxation and cognitive behavioral therapy in the treatment of generalized anxiety disorder. J Clin Consult Psychol 1993; 61(4): 611-619.
Hamilton Anxiety Rating Scale, HAM-A
Below is a of phrases that describe certain feeling that people have Rate the patients by finding the answer which best describes the extent to which he/she has these conditions. Select one of the five responses for each of the fourteen questions.
0 = Not present, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Very severe.
1. Anxious mood [ [ [ [ [
Worries, anticipation of the worst, fearful anticipation, irritability
2. Tension [ [ [ [ [
Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax.
3. Fears TT [[ [ T [
Of dark, of strangers, of being left alone, of animals, of traffic, of crowds.
4. Insomnia [ [ [ [ T
Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors.
5. Intellectual [ [ [T [
Difficulty in concentration, poor memory.
6. Depressed mood T [ [ T [
Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal swing.
7. Somatic (muscular) [ [ [ [ [
Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone.
8. Somatic (sensory) [ [ [ [ [
Tinnitus, blurring of vision, hot and cold flushes, feelings of weakness, pricking sensation.
9. Cardiovascular symptoms [ [ [ [ [
Tachycardia, palpitations, pain in chest, throbbing of vessels, fainting feelings, missing beat.
10. Respiratory symptoms [T] T T T T
Pressure or constriction in chest, choking feelings, sighing, dyspnea.
11. Gastrointestinal symptoms T T T T T
Difficulty in swallowing, wind abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation.
12. Genitourinary symptoms T T T T T
Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence
13. Autonomic symptoms T T T T T
Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair.
14. Behavior at interview T T T T T
Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, etc.