Best-worst scaling in studying the impact of the coronavirus pandemic on health professionals in Ghana

Abstract

In this study, we utilized a best-worst scaling experiment design to assess the potential factors associated with depression, anxiety, and stress among health professionals following the experience of the COVID-19 pandemic. The maximum difference model was performed to analyze the potential risk factors associated with depression, anxiety, and stress. As a case study, a total of 300 health professionals in Ghana were included in the survey. The majority, 112 (68.7%) male health professionals and 97 (70.8%) female health professionals reported that they had encountered suspected COVID-19 patients. 83 (50.9%) of the male health professionals and 76 (55.5%) of the female health professionals reported that they had encountered confirmed COVID-19 patients. A considerable proportion of the males 59 (36.2%) and females 57 (41.6%) health professionals reported coming into direct contact with COVID-19 lab specimens. The findings indicated that a high proportion of health professionals encountered suspected or confirmed COVID-19 patients, while a considerable proportion had direct contact with COVID-19 lab specimens leading to psychological problems. Risk factors such as contact with confirmed COVID-19 patients, the relentless spread of the coronavirus, death of patients and colleagues, shortage of medical protective equipment, direct contact with COVID-19 lab specimens, and the permanent threat of being infected should be given special attention, and necessary psychological intervention provided for health professionals endorsing these risk factors. Improving the supply of medical protective equipment to meet occupational protection practices, sufficient rest, and improving the vaccination of the population might help safeguard health professionals from depression, anxiety, and stress. Our results provide insight into policy discussions on the mental health of health professionals and interventions that are essential to enhance psychological resilience.

Keywords

COVID-19 health professionals anxiety stress depression best-worst scaling experiment

1. Introduction

The Coronavirus Disease 2019 (COVID-19) is an acute respiratory disease caused by SARS-CoV-2, a novel coronavirus closely related to SARS-Covid. The COVID-19 outbreak began on December 31, 2019, in Wuhan, China, and quickly spread around the world; and was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020 (DynaMed, 2022; WHO, 2022). As of May 15, 2022, over 518 million cases, including over 6.2 million deaths, have been reported worldwide (DynaMed, 2022). The virus is transmitted person-to-person by both symptomatic and asymptomatic persons through close contact (within 6 feet) via respiratory droplets, aerosols and possibly through contact with fomites (Nguyen et al., 2021; DynaMed, 2022). Fever, cough, myalgia or tiredness, pneumonia, dyspnea, headache, diarrhoea, hemoptysis, runny nose, and phlegm-producing cough are all symptoms of COVID-19 (Adhikari et al., 2020; Harapan et al., 2020; Chew et al., 2020).

Ghana, the context under investigation in this study, has not been spared the coronavirus crisis. The health ministry reported the first two cases of COVID-19 in Ghana on March 12, 2020 (Sightsavers, 2020). Because of the pandemic, the government of Ghana established an Inter-Ministerial Committee on Coronavirus Response, which quickly reported measures to contain the spread of COVID-19, in addition to the WHO-recommended preventive guidelines to protect human-to-human transmission of COVID-19, such as social distancing, ban on public and religious gatherings, regular personal hygiene, use of face masks, cover the mouth and nose while sneezing or coughing, one per seat in public vehicles, temporary closing of schools, among others (Yeboah et al., 2020; Ho et al., 2021). However, these preventive guidelines to protect human-to-human transmission of COVID-19 may have adverse effect on the economy and people’s life. A study to examine the influence of the national social distancing on the health-related quality of life and economic well-being of Vietnamese citizens under COVID-19 pandemic reported higher proportion (38.7%) of anxiety/depression because of social distancing as well as ban on outdoor recreation (Tran et al., 2020) Another study that compared the levels of psychological impact of the COVID-19 pandemic as well as levels of anxiety and depression and face mask use on Poles and Chinese observed that Poles had significantly higher levels of anxiety, depression, and stress as compared to Chinese because the proportion of Poles who used masks were significantly less than Chinese (Wang et al., 2020). Report shows that nurses were more likely to practice precautionary measures against the COVID-19 compared to medical doctors. Healthcare workers with higher educational level and who had adequate knowledge of transmission were also more likely to engage in the preventive guidelines than their counterparts (Nguyen et al., 2021).

Because of the COVID-19 outbreak’s rapid nature and the virus’s contagious strength, it will surely pose a significant threat to people’s physical health and lives as well as cause psychological issues, including fear, anxiety, depression, and stress. A study on the impact of COVID-19 on three continents (i.e., China, Poland, Philippines, Spain, Iran, United States, Pakistan, and Vietnam) and its relationship with physical and mental health reported common physical symptoms such as headache (28.62%), cough (20.73%), sore throat (19.7%), breathing difficulties (11.56%), rigors or chills (11.27%), fever (10.99%), coryza (19.32%), myalgia (16.37%), dizziness (15.26%) and gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) (16.97%). Moreover, citizens of Pakistan (mean $=$ 14.41), Poland (mean $=$ 13.98) and Spain (mean $=$ 13.93) experienced the highest level of stress. Pakistan (mean $=$ 8.81), Iran (mean $=$ 7.83) and Poland (mean $=$ 7.45) were the three countries with highest level of anxiety, while Pakistan (mean $=$ 11.70), Poland (mean $=$ 9.73) and Spain (mean $=$ 8.39) were the three countries with highest level of depression. Vietnam has the lowest stress (mean $=$ 3.24), anxiety (mean $=$ 2.09) and depression (mean $=$ 2.23) (Wang et al., 2021). A variety of stressors, anxiety and mental disease aggravation has been linked to the COVID-19 pandemic, and healthcare workers are not left off the hook of these mental diseases because of their responsibility to provide health and treatment to patients (Salari et al., 2020; Søvold et al., 2021; Michie, 2002; Zheng et al., 2021).

In low-and-middle-income countries where the healthcare delivery system is generally inadequate and emergency health care is limited, the presence of a pandemic such as the COVID-19 poses a real threat, which affects mental health and well-being of the health care workers who aid in the treatment of the patients (Tan et al., 2020; Chew et al., 2020; Carter et al., 2020; Wang et al., 2021; Dong et al., 2022). Recent studies have explored factors associated with fear, depression, anxiety, stress and other mental diseases among health professionals amidst the outbreak of COVID-19 pandemic (Ofori et al., 2021; Salari et al., 2020; Chew et al., 2020; Adom et al., 2021; Asiamah et al., 2021; Gyasi, 2020; Pham et al., 2021), but they did not quantify the independent factors associated with fear, depression, anxiety, and stress among health professionals amidst the outbreak of COVID-19 pandemic.

The present study provides timely quantitative evidence on potential factors associated with depression, anxiety, and stress among health professionals amidst the outbreak of COVID-19 pandemic in Ghana. To the best of our knowledge, the present work is the first detailed study that utilizes the maximum difference experimental design approach to investigate factors associated with depression, anxiety, and stress among health professionals amidst the outbreak of COVID-19 pandemic in Ghana. This finding of this study will contribute to policy discussions as well as decision making on ways to address the issue of depression, anxiety, and stress among health professionals in developing countries including Ghana.

2. Method

2.1 Sample and data collection

The data for this study comes from a cross-sectional face-to-face survey conducted in September 2021 among health professionals who were Ghanaians and living in the Greater Accra region. This city was selected because it emerged as the epicenter for the spread of COVID-19 in Ghana and health professionals were most likely at risk of contracting the coronavirus (Odikro et al., 2020; Statista, 2022). The random sampling approach was used to sample health professionals in nine hospitals. In the present study, we computed the minimum possible sample size by following Hensher et al. (2005). Achieve this, 50% allowable deviation 5% level of confidence, 1.96 inverse cumulative distribution function of a standard normal distribution and 50% probability of the population indicating preferences for either one of the options was considered during the sample size computation. The final minimum permissible sample size was 103. This number reflects the minimum number of health professionals required for the BWS study. Hence, our anticipated sample size of 300 health professionals was enough for this study. All the 300 health professionals were used as the final analysis sample because there was a total response. Permission to collect data was obtained in the form of verbal consent from the respondents, after duly explaining to them the purpose of the present study. Further, respondents were informed that their participation was voluntary, and they are at liberty to decide to take part or not in the study.

2.2 Experimental design

Discrete choice experiments (DCEs) are widely used in health economics and are particularly useful in measuring preferences for health services (Bansal et al., 2022; Clark et al., 2014). More recently, DCEs have been used for mental health studies (Rowen et al., 2022; Larsen et al., 2021; Phillips et al., 2021; Chorus et al., 2020). However, best-worst scaling (BWS) experiments represent a viable option. BWS is a cutting-edge method for conducting experiments. One of its key advantages is the ability to estimate the relative importance of all attributes on a common scale (Najafzadeh et al., 2012), which is essential for this study. In BWS experiments, each respondent chooses the most preferred and the least preferred attribute among a set of three or more attributes presented in each task.

This study utilizes a BWS experiment, where the identification of an initial list of potential factors (attributes) associated with depression, anxiety, and stress among health professionals in Ghana during the COVID-19 pandemic was guided by an extensive literature review and expert consultation (Wittenberg et al., 2016). A Focus group discussion with thirteen healthcare workers was used to reduce the initial list of the potential risk factors to ten most relevant attributes. These attributes include shortage of medical protective equipment, frequent isolation from family, death of patients and colleagues, direct contact with COVID-19 lab specimen, contact with confirmed COVID-19 patients, relentless spread of the coronavirus, contact with suspected COVID-19 patients, workload, permanent threat of being infected, and lack of sufficient rest.

A full factorial design includes all possible combinations of attributes and their corresponding levels. In the present setting, the full factorial design resulted in 210 experimental conditions (profiles). Since it would not be possible to present all 210 profiles to respondents and to minimize information overload, the JMP Pro statistical software was used to generate optimal fifteen BWS sets or tasks of four attributes each for the survey. The order of the four attributes within each set was randomly assigned before the questionnaire was administered to each health professional (Wittenberg et al., 2016) through interviewer-led survey administration. During the survey, the interviewers explained more carefully and supervised the respondents on how to answer the questions. After these, the health professionals were asked to choose the fifteen best-worst scaling tasks of four factors associated with depression, anxiety, and stress. For each task, the health professionals indicated first which attribute is the most and least factor associated with depression, anxiety, and stress among health professionals. Each set of the four attributes was presented singly. Before completing these BWS tasks, health professionals were asked tick-box questions about their background and experience during the COVID-19 pandemic. The average survey completion time was 12 minutes. No incentive was provided to health professionals for completing the survey. Permission to collect data was obtained in the form of verbal consent from the respondents after duly explaining to them the purpose of the study. Further, respondents were informed that their participation was voluntary, and they were at liberty to decide whether to take part or not in the study.

2.3 Model specification and estimation

We employ the maximum difference model, which has its basis in random utility theory (McFadden, 1974; Flynn & Marley, 2014), to estimate the effects of factors associated with depression, anxiety, and stress. Let $S$ with $|S|>$ 2 denote the finite set of potentially available choice options in a given best-worst scaling task and let $D(S)$ denote the experimental design generated in JMP Pro (Version 16.0), that is the set of (sub)sets of choice alternatives involving factors associated with depression, anxiety, and stress that occurs in this study. For any set $Y\in D(S)$ , $Y\subseteq S$ with $|Y|>$ 2, let $B_{Y}(x)$ denote the probability that alternative $x$ is chosen as best in set $Y$ , $W_{Y}(y)$ the probability that alternative $y$ is chosen as worst in a set $Y,$ and $\textit{BW}_{Y}(x,y)$ the probability that alternative $x$ is chosen as best in $Y$ a set, and the alternative $y\neq x$ is chosen as worst in $Y$ . Now, the best choice model assumes that there is a scale $\mu$ such that for all $y\in Y\in D(S)$ ,

$\displaystyle B_{Y}(y)=\frac{e^{\mu(y)}}{\sum_{z\in Y}e^{\mu(z)}},$ (1)

where the value $\mu(y)$ for an option $y$ is interpreted as the utility for that option.

Additionally, the parallel worst choice model assumes that there is a scale $v$ such that for all $y\in Y\in D(S)$ ,

$\displaystyle W_{Y}(y)=\frac{e^{\nu(y)}}{\sum_{z\in Y}e^{\nu(z)}}.$ (2)

Now, assume that both Eqs (1) and (2) hold and that the choice probabilities on 2- element sets satisfy the reasonable condition for all distinct pairs. $x,y\in Y\in D(S)$ ,

$\displaystyle B_{\{x,y\}}(x)=W_{\{x,y\}}(y),$

that is, we have

$\displaystyle W_{Y}(y)=\frac{e^{-\mu(y)}}{\sum_{z\in Y}e^{-\mu(z)}}.$ (3)

Assume that the best (respectively, worst) choice probabilities satisfy Eqs (1) and (3) and that the utility of a choice alternative in the selection of the best option is the negative of the utility of that option in the selection of the worst option, and this utility-scale $\mu$ is such that for all $x,y\in Y\in D(S)$ , $x\neq y$ ,

$\displaystyle\textit{BW}_{Y}(x,y)=\frac{e^{[\mu(x)-\mu(y)]}}{\sum_{\{p,q\}\in Y% }e^{[\mu(p)-\mu(q)]}}.$ (4)

Here, a health professional independently selects the best (or most) and worst (or least) option of factors associated with depression, anxiety, and stress. All potential factors were treated as generic variables.

The survey data obtained were analyzed using the maximum difference model Eq. (4). John’s Macintosh Project Pro (JMP Pro Version 16.0) was used for all statistical analyses including computation of standard errors (SE). Model fit was evaluated according to likelihood ratio (L-R) Chi-square value, corrected Akaike’s Information Criterion (AICc), Bayesian Information Criterion (BIC), and $p$ -value (Schaffer et al., 2020). In particular, a likelihood ratio test was carried out to test the hypothesis that the parameters between different numbers of profiles in the BWS choice set were not statistically different. A probability value ( $p$ -value) less than or equal to a prespecified significant level of 1%, 10% and 5% indicates that the model is statistically significant. Thus, the model fits well than a model with no predictors (Rajasulochana et al., 2016). Because p-values are not directly reported for the utility estimates, we leverage the 95% confidence interval (C.I) to assess the significance of the various factors of depression, anxiety, and stress. It should be noted that for 95% of confidence probability the C.I is defined as coefficient plus-minus 2 $*$ SE. Here we mention that significant attributes are the only preference estimates for which the 95% C.I do not include zero. A high/low preference for a specific factor associated with depression, anxiety, and stress is backed by a significant positive/negative utility estimate (preference weight).

3. Results

3.1 Demographic description

Table 1
Demographic characteristics of health professionals screened for depression, anxiety, and stress symptoms in Ghana during the COVID-19 pandemic

Variable	Category	Male (%)	Female (%)
Age (years)	Below 30	19.6	16.1
	31–40	45.4	48.9
	41–50	22.7	24.1
	Above 50	12.3	10.9
Marital status	Single	49.1	41.6
	Married	38.7	38.0
	Divorced	3.1	5.1
	Cohabitation	5.5	9.5
	Widowed	3.7	5.8
Profession	Physician	25.8	5.1
	Nurse	39.3	67.2
	Pharmacist	17.8	19.0
	Other	17.2	8.8
Work experience (years)	1–10	70.6	70.1
	11–20	20.9	18.2
	Above 20	8.6	11.7
Place of work	COVID-19 wards	19.0	23.4
	Other wards	81.0	76.6
Duty (hours per week)	Below 50	57.1	48.2
	50–70	33.7	43.8
	Above 70	9.2	8.0
Sleep duration	Below 7 hours	58.9	60.6
	7 hours and above	41.1	39.4
Have come into contact with patients	Yes	68.7	70.8
with suspected COVID-19 infection	No	31.3	29.2
Have come into contact with patients	Yes	50.9	55.5
with confirmed COVID-19 infection	No	49.1	44.5
Have come into direct contact	Yes	36.2	41.6
with COVID-19 lab specimen	No	63.8	58.4

A total of 300 health professionals participated in this study with a 100% response rate. As shown in Table 1, most participants were female (48.9%) within the age range 31–40 years. A high number of the male participants were single (49.1%). The health professionals screened were female nurses (67.2%) with 1 to 10 years of working experience (70.1%), worked in other wards (76.6%), had encountered patients with confirmed COVID-19 infection (55.5%), as well as came into direct contact with COVID-19 lab specimens (41.6%). More that half of the male health professionals worked below fifty hours per week (57.1%), experienced a sleep duration below seven hours (58.9%), and had encountered patients with suspected COVID-19 infection (70.8%).

3.2 Maximum difference model results

Table 2
Maximum difference model estimates of factors that cause depression, anxiety, and stress among health professionals in Ghana screened during the COVID-19 pandemic

Attributes	Estimate	Standard error (SE)
Contact with confirmed COVID-19 patients	0.249	0.043
Contact with suspected COVID-19 patients	$-$ 0.045	0.043
Death of patients and colleagues	0.141	0.043
Direct contact with COVID-19 lab specimen	0.133	0.043
Frequent isolation from family	$-$ 0.234	0.043
Lack of sufficient rest	$-$ 0.300	0.043
Shortage of medical protective equipment	0.138	0.043
Permanent threat of being infected	0.128	0.043
Relentless spread of the virus	0.232	0.043
AICc	10939.214
BIC	10990.598
$-$ 2 $*$ LogLikelihood	10921.133
L-R ChiSquare	DF	Prob $>$ ChiSq
255.977	9	$<$ 0.0001 ${}^{*}$

The likelihood ratio (L-R) Chi-square value of 255.977 with 9 degrees of freedom and $p$ -value ( $p<$ 0.0001) (Table 2), is an indication that the maximum difference model as a whole is statistically significant at the 0.01, 0.1 and 0.05 level. As was already pointed out, a utility estimate is statistically significant if its associated 95% C.I does not include zero. The utility estimates of the various attributes that cause depression, anxiety, and stress among health professionals screened amidst the COVID-19 pandemic have the expected sign at the 95% C.I. Except for health professionals having an encounter with suspected COVID-19 patients, all of these attributes were significantly associated with depression, anxiety, and stress among health professionals in the maximum difference model results (Table 2). The relative importance attached to these attributes is represented by the marginal utility estimates (MUE) with their respective marginal probability (MP) values. Contact with confirmed COVID-19 patients has the highest effect (MUE: 0.2497; MP: 0.1252; 95%C.I: 0.1650, 0.3347) associated with depression, anxiety, and stress among health professionals. Other higher effects on depression, anxiety, and stress were observed for relentless spread of the virus (MUE: 0.2328; MP: 0.1231.; 95%C.I: 0.1481, 0.3177), followed by death of patients and colleagues (MUE: 0.1414; MP: 0.1123.; 95%C.I: 0.0572, 0.2259), shortage of medical protective equipment (MUE: 0.1385; MP: 0.1120; 95%C.I: 0.0541, 0.2231), direct contact with COVID-19 lab specimen (MUE: 0.1337; MP: 0.1115; 95%C.I: 0.0495, 0.2182) and permanent threat of being infected (MUE: 0.1288; MP: 0.1109; 95%C.I: 0.0443, 0.2134).

Further, we considered all pairwise-comparison of attributes that cause depression, anxiety, and stress among health professionals amidst the COVID-19 pandemic. Our results reveal that the odds of a health professional having depression, anxiety, and stress as a result of having an encounter with confirmed COVID-19 patients is; (OR: 1.11428, 1.12292, 1.62311, 1.73286, 1.11761, 1.12851, 1.01703, and 2.00209) times higher than death of patients and colleagues (OR: 0.89744), having direct contact with COVID-19 lab specimen (OR: 0.89053), frequent isolation from family (OR: 0.6161), lack of sufficient rest (OR: 0.57708), shortage of medical protective equipment (OR: 0.89477), permanent threat of being infected (OR: 0.88612), relentless spread of the virus (OR: 0.98326), and workload (OR: 0.49948), respectively. Death of patients and colleagues has a higher likelihood of causing depression, anxiety, and stress among health professionals (OR: 1.00776, 1.45664, 1.55514, 1.00299, 1.01278, and 1.79676) than direct contact with COVID-19 lab specimen (OR: 0.9923), frequent isolation from family (OR: 0.68651), lack of sufficient rest (OR: 0.64303), shortage of medical protective equipment (OR: 0.99702), permanent threat of being infected (OR: 0.98739), and workload (OR: 0.55656), respectively. Moreover, direct contact with COVID-19 lab specimens has a higher probability of causing depression, anxiety, and stress among health professionals (OR: 1.44543, 1.54317, 1.00498, and 1.78293) than frequent isolation from family (OR: 0.69184), lack of sufficient rest (OR: 0.64802), permanent threat of being infected (OR: 0.99505), and workload (OR: 0.56088), respectively. Shortage of medical protective equipment (OR: 1.45231), permanent threat of being infected (OR: 1.43827), and the relentless spread of the virus (OR: 1.59593) have a higher likelihood of causing depression, anxiety, and stress among health professionals than frequent isolation from family (0.68856, 0.69528, and 0.62659, respectively). Additionally, shortage of medical protective equipment (OR: 1.55051), permanent threat of being infected (OR: 1.53552), and the relentless spread of the virus (OR: 1.70385) have a higher likelihood of causing depression, anxiety, and stress among health professionals than lack of sufficient rest (OR: 0.64495, 0.65124, 0.58691, respectively). Further, the permanent threat of being infected as well as the relentless spread of the virus have a higher likelihood (OR: 1.7741, 1.96857) of causing depression, anxiety, and stress among health professionals than workload (OR: 0.56367, 0.50798).

4. Discussion

The principal aim of our study was to employ the maximum difference experimental design approach to assess the factors associated with the prevalence of depression, anxiety, and stress among health professionals amidst the COVID-19 pandemic in Ghana. We found that 68.7% of the male health professionals and 70.8% of the female health professionals have encountered patients with suspected COVID-19 infection. In comparison, 50.9% of the male health professionals as well as 55.5% of the female health professionals have encountered patients with confirmed COVID-19 infection. A high proportion 58.9% of the male health professionals and 60.6% of the female health professionals screened experienced a sleep duration below seven hours.

A key finding of this study is that independent factors such as contact with confirmed COVID-19 patients, the relentless spread of the coronavirus, death of patients and colleagues, shortage of medical protective equipment, direct contact with COVID-19 lab specimens and the permanent threat of being infected were associated with depression, anxiety, and stress among health professionals during the COVID-19 outbreak in Ghana. In contrast, factors such as frequent isolation from family and lack of sufficient rest were the lower effects associated with the prevalence of depression, anxiety, and stress among health professionals.

An encouraging result from our analysis is that health professionals who have encountered confirmed COVID-19 patients were more likely to be depressed, stressed and anxious. This is not surprising because as the number of patients visited increases, healthcare professionals’ risk of contracting COVID-19 becomes high (Le et al., 2021; Ho et al., 2021). These results highlighted the need for early identification and the importance of effectively recognizing and treating the milder symptoms associated with depression, stress, and anxiety among health professionals before they evolve into more complex and severe psychological responses. Childcare, family services, and mental health support services with a focus on catering to healthcare professionals and their families should be made available (Tran et al., 2022). In correspondence with several previous studies, healthcare workers with a higher patient visit as well as treating patients exposed to COVID-19 or contaminated were more likely to be depressed, anxious, and/or stressed (Dagne et al., 2021; Lai et al., 2020; Kang et al., 2020; Wheaton et al., 2020; Ho et al., 2021). When conpared with nurses in Singapore, Malaysia, and Indonesia, those in Vietnam exhibited the highest levels of depressive, stressful, intrusive, avoidant, and hyperarousal symptoms. Singapore’s nurses had the most anxiety (Dong et al., 2022) Surgical providers who knew of someone with COVID-19 were more likely to test positive for depression, stress and post-traumatic stress disorder. Surgical specialities that operated in the head and neck region showed increased psychological discomfort among its surgeons (Tan et al., 2022). Another study in Vietnam highlighted marginal impacts of the COVID-19 pandemic on the work and life of hospital staff (Pham et al., 2021).

Our finding indicated that the relentless spread of the coronavirus was associated with depression, stress, and anxiety among health professionals. This finding was consistent with several previous studies (Dagne et al., 2021; Abolfotouh et al., 2017; Wang et al., 2020), arguing that with the rapid spread of the epidemic, more and more health workers might feel vulnerable to getting contaminated and feared about the shortage of emergency medical equipment supplies. Accordingly, the mental health of health professionals should be paid special attention to, and they should be provided with the necessary psychological intervention (Chew et al., 2020). Death of patients and colleagues was also found to be associated with depression, stress, and anxiety among health professionals. As a coping strategy, health professionals can avoid news about COVID-19 and related deaths (Ofori et al., 2021).

The current study found that a shortage of medical protective equipment was associated with depression, stress, and anxiety. It is possible that even though medical protective equipment such as face masks and gloves were provided, they may not have been deemed adequate in terms of quantities. This finding was consistent with several previous studies (Cai et al., 2020; Ofori et al., 2021; Dagne et al., 2021; Zheng et al., 2021) arguing that adequate medical protective equipment not only protects health workers from infectious disease but also help reduce COVID-19 related adverse impacts on the mental health of healthcare workers. We found that direct contact with COVID-19 lab specimens and the permanent threat of being infected were associated with the prevalence of depression, anxiety, and stress among health professionals. This might be explained by the fact that COVID-19 is a human-to-human transmissible, highly morbid, and potentially fatal disease. This finding was consistent with previous studies (Dagne et al., 2021), arguing that coming in contact with patients’ lab specimens or bodily fluids/blood were risk factors for anxiety.

Our study specially examined all pairwise comparisons between the attributes. Our finding suggested high prevalence of depression, anxiety, and stress among health professionals who have come into direct contact with confirmed COVID-19 patients than those who have had direct encounter with suspected COVID-19 patients, witness death of patients and colleagues, direct contact with COVID-19 lab specimen, experience frequent isolation from family, lack of sufficient rest, shortage of medical protective equipment, permanent threat of being infected, relentless spread of the virus, and workload.

We found that the death of patients and colleagues have a higher likelihood of causing depression, anxiety, and stress among health professionals than direct contact with COVID-19 lab specimen, frequent isolation from family, lack of sufficient rest, shortage of medical protective equipment, permanent threat of being infected, and workload. However, the relentless spread of the coronavirus has a higher likelihood of causing depression, anxiety, and stress among health professionals than witnessing the death of patients and colleagues.

Moreover, direct contact with COVID-19 lab specimens has a higher probability of causing depression, anxiety, and stress among health professionals than frequent isolation from family, lack of sufficient rest, permanent threat of being infected, and workload. It is shown that the shortage of medical protective equipment and the relentless spread of the coronavirus has a high likelihood of contributing to the prevalence of depression, anxiety, and stress among health professionals than having direct contact with COVID-19 lab specimens. Also, frequent isolation from family has a higher likelihood of causing depression, anxiety, and stress among health professionals than lack of sufficient rest and workload. It is worth noting that shortage of medical protective equipment, permanent threat of being infected, and the relentless spread of the coronavirus have a high likelihood of causing depression, anxiety, and stress among health professionals than frequent isolation from family.

Lack of sufficient rest has a higher probability of causing depression, anxiety, and stress among health professionals than workload. Moreover, our results suggest that shortage of medical protective equipment, permanent threat of being infected, and the relentless spread of the coronavirus have a high likelihood of causing depression, anxiety, and stress among health professionals than lack of sufficient rest. Shortage of medical protective equipment has a high probability of causing depression, anxiety, and stress among health professionals than the permanent threat of being infected and workload. In contrast, the relentless spread of the coronavirus on the other hand, has a high probability of causing depression, anxiety, and stress among health professionals than the shortage of medical protective equipment. Additionally, the permanent threat of being infected has a higher probability of causing depression, anxiety, and stress among health professionals than workload. In comparison, the relentless spread of the coronavirus has a higher probability of causing depression, anxiety, and stress among health professionals than the permanent threat of being infected. To this end, we note that the relentless spread of the coronavirus had a high likelihood of causing depression, anxiety, and stress among health professionals than workload.

Indeed, the COVID-19 outbreak has brought attention to the vulnerability of mental fortitude and the necessity of offering the country a coordinated psychological intervention. It is recommended to offer online psychotherapy to people with a mental health condition through video conferencing tools like Zoom to reduce the risk of virus transmission from in-person therapy. However, to better meet the needs of the country during this epidemic, it would be beneficial to offer online or smartphone-based psychoeducation about the virus outbreak, promote mental wellness, and start psychological interventions such as cognitive behavior therapy (CBT) as well as internet cognitive behavioral therapy (I-CBT), which may challenge patients’ cognitive biases in those who exaggerate their risk of contracting and dying from the virus (Ho et al., 2020). Internet CBT can treat psychiatric symptoms such as insomnia (Soh et al., 2020). Moreover, behavioural therapy may teach relaxation techniques to combat anxiety.

The results of our study should be interpreted on the background of some limitations. First, the study was conducted in a special geographic region, so it might not represent the general population. However, since health professionals working in the Greater Accra region were most at risk of contracting the coronavirus because this region was the epicentre of the pandemic in Ghana, their opinion might reflect the intentions of other health professionals in the other regions of Ghana. Second, this study estimates the effect of some specific factors associated with depression, anxiety, and stress among health professionals. However, several environmental, genetic, and physiological factors that may play a significant role in causing depression, anxiety, and stress among subjects are not considered here. These omitted attributes might induce biases in the maximum difference utility estimates. Future investigations might consider including these factors to capture this kind of information to address omitted attribute biases.

Despite these limitations, the present study provides timely quantitative evidence on factors associated with depression, anxiety, and stress among health professionals during the COVID-19 outbreak in Ghana. To the best of our knowledge, it is also the first detailed study on factors associated with or cause of depression, anxiety, and stress among health professionals during the COVID-19 outbreak in Ghana that utilizes the maximum difference experimental design approach. This study will contribute to policy discussions on ways to address the issue of depression, anxiety, and stress among health professionals in developing countries.

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Best-worst scaling in studying the impact of the coronavirus pandemic on health professionals in Ghana

Abstract

Keywords

1. Introduction

2. Method

2.1 Sample and data collection

2.2 Experimental design

2.3 Model specification and estimation

3.1 Demographic description

Table 1 Demographic characteristics of health professionals screened for depression, anxiety, and stress symptoms in Ghana during the COVID-19 pandemic

Table 2 Maximum difference model estimates of factors that cause depression, anxiety, and stress among health professionals in Ghana screened during the COVID-19 pandemic

References

Table 1
Demographic characteristics of health professionals screened for depression, anxiety, and stress symptoms in Ghana during the COVID-19 pandemic

Table 2
Maximum difference model estimates of factors that cause depression, anxiety, and stress among health professionals in Ghana screened during the COVID-19 pandemic