Psychological Impact of COVID- 19 on the Ophthalmologists in Iran
Purpose: To identify the psychological impact of coronavirus disease on ophthalmologists practicing in Iran between August and December 2020.
Methods: In this cross-sectional online survey, a standard Patient Health Questionnaire- 9 (PHQ- 9) was completed by 228 ophthalmologists who were practicing in Iran. The PHQ- 9 questionnaire was revised by adding two additional questions specifically applicable for the assessment of the psychological impact of coronavirus disease on the Iranian ophthalmologists. An organized classification regarding the assessment of different depression severities identified as no (0–4), mild (5–9), moderate (10–14), or severe (15–21) was then considered for data analysis.
Results: The mean age of our participants was 49.0 ± 15.61 years and the majority of them (67.1%) were male. Depression was discovered in 73.68% (n = 168) with different severities ranging from mild (n = 61, 26.75%), moderate (n = 63, 27.63%), and severe (n = 44, 19.3%). It was found that participants with depression were older as compared to those without depression (P = 0.038). Higher percentages of severe depression were noticed in the high-risk regions contaminated with coronavirus as compared to the other low-risk regions (P = 0.003). Based on multivariable models, we determined that ophthalmologists who were somewhat concerned about their training/ profession (OR: 0.240; 95% CI: 0.086–0.672; P = 0.007) and those with no concerns about their income had lower association with depression (OR: 0.065; 95% CI: 0.005–0.91; P = 0.042).
Conclusion: High prevalence of depression was observed among older-aged Iranian ophthalmologists living in high-risk contaminated regions who possessed serious concerns with respect to their training/profession and income. It is recommended that the health policymakers of Iran pay more attention to the ophthalmologists who experience the aforementioned factors.
Coronavirus Disease, Iran, Ophthalmologists, Psychological Impact
1. Tavakoli A, Vahdat K, Keshavarz M. Novel coronavirus disease 2019 (COVID-19): an emerging infectious disease in the 21st century. Iran South Med J 2020;22:432–450.
2. Peyronnet V, Sibiude J, Deruelle P, Huissoud C, Lescure X, Lucet J-C, et al. Infection par le SARS-CoV-2 chez les femmes enceintes. État desconnaissances ET proposition de prise en charge. CNGOF, Gynécologie Obstétrique Fertilité & Sénologie; 2020. Available from: https://doi.org/10.1016/j. gofs.2020.03.014.
3. Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al- Jabir A, et al. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71–76.
4. Farnoosh G, Alishiri G, Hosseini Zijoud SR, Dorostkar R, Jalali Farahani A. Understanding the 2019-novel coronavirus (2019-nCoV) and coronavirus disease (COVID- 19) based on available evidence – a narrative review. J Mil Med 2020;22:1–11.
5. Rajavi Z, Safi S, Mohammadzadeh M. Guidance for ophthalmologists and ophthalmology centers during the COVID-19 pandemic. J Ophthalmic Vis Res 2020;15:438– 441.
6. Wang D, Hu B, Chang Hu C, Fangfang Zhu F, Xing Liu X, Jing Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061–1069.
7. Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun 2020;89:531–542.
8. Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care 2020;9:241–247.
9. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr 2020;33:e100213.
10. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiat 2020;7:e14.5
11. Amerio A, Bianchi D, Santi F, Costantini L, Odone A, Signorelli C, et al. Covid-19 pandemic impact on mental health: a web-based cross-sectional survey on a sample of Italian general practitioners. Acta Biomed 2020;91:83– 88.
12. Seah I, Agrawal R. Can the coronavirus disease 2019 (COVID-19) affect the eyes? A review of coronaviruses and ocular implications in humans and animals. Ocul Immunol Inflamm 2020;28:391–395.
13. Khanna RC, Honavar SG, Metla AL, Bhattacharya A, Maulik PK. Psychological impact of COVID- 19 on ophthalmologists-in-training and practising ophthalmologists in India. Indian J Ophthalmol 2020;68:994–998.
14. Grover R, Dua P, Juneja S, Chauhan L, Agarwal P, Khurana A. Depression, anxiety and stress in a cohort of registered practicing ophthalmic surgeons, post lockdown during COVID-19 pandemic in India. Ophthalmic Epidemiol 2020;13:1–8.
15. Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning province, China: a cross-sectional study. Int J Environ Res Public Health 2020;17:2381. 3.
16. Alahmadi AS, Alhatlan HM, Bin Helayel H, Khandekar R, Al Habash A, Al-Shahwan S. Residents’ perceived impact of COVID-19 on Saudi ophthalmology training programs – a survey. Clin Ophthalmol 2020;14:3755–3761.
17. Khamseh ME, Baradaran HR, Javanbakht A, Mirghorbani M, Yadollahi Z, Malek M. Comparison of the CES-D and PHQ-9 depression scales in people with type 2 diabetes in Tehran, Iran. BMC Psychiatry 2011;11:61.
18. Spitzer R, Kroken K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA 1999;282:1737.
19. Kocalevent RD, Hinz A, Brahler E. Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry 2013;35:551–555.
20. https://coronomy.ir/20/11/2020. 1 21. Elbay RY, Kurtulmus A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res 2020;290:113130.
22. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open 2020;3:e203976.
23. Chambers R, Campbell II. Anxiety and depression in general practitioners: associations with type of practice, fundholding, gender and other personal characteristics. Fam Pract 1996;13:170–173.
24. WHO. Depression and other common mental disorders: global health estimates. Geneva: WHO; 2017 [cited 2020 Jun 15]. Available from: https:// apps.who.int/iris/bitstream/handle/10665/254610/WHOMSD- MER-2017.2 eng.pdf?sequence=1
25. Cyranowski JM, Frank E, Young E, Shear MK. Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model. Arch Gen Psychiatry 2000;57:21–27.
26. Ford DE, Erlinger TP. Depression and C-reactive protein in US adults: data from the third national health and nutrition examination survey. Arch Intern Med 2004;164:1010–1014.
27. Almater AI, Tobaigy MF, Younis AS, Alaqeel MK, Abouammoh MA. Effect of 2019 coronavirus pandemic on ophthalmologists practicing in Saudi Arabia: a psychological health assessment. Middle East Afr J Ophthalmol 2020;27:79–85.
28. Hussain R, Singh B, Shah N, Jain S. Impact of COVID-19 on ophthalmic specialist training in the United Kingdomthe trainees’ perspective. Eye 2020;34:2157–2160.